Provider Demographics
NPI:1174026264
Name:SIRI K. ZIESE DDS INC.
Entity Type:Organization
Organization Name:SIRI K. ZIESE DDS INC.
Other - Org Name:ZIESE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SIRI
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:ZIESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-622-2862
Mailing Address - Street 1:1008 FOWLER WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5701
Mailing Address - Country:US
Mailing Address - Phone:530-622-2862
Mailing Address - Fax:530-622-2072
Practice Address - Street 1:1008 FOWLER WAY STE A
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5701
Practice Address - Country:US
Practice Address - Phone:530-622-2862
Practice Address - Fax:530-622-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD56147261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========6Medicaid