Provider Demographics
NPI:1225370687
Name:SIECZKOWSKI, DONALD P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:SIECZKOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5512
Mailing Address - Country:US
Mailing Address - Phone:216-860-2700
Mailing Address - Fax:215-860-7027
Practice Address - Street 1:508 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5512
Practice Address - Country:US
Practice Address - Phone:216-860-2700
Practice Address - Fax:215-860-7027
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0269521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1225045826OtherBILLING NPI NUMBER