Provider Demographics
NPI:1245235514
Name:SIEGEL, MICHAEL ALAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 SOUTHERN ORCHARD RD E
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6962
Mailing Address - Country:US
Mailing Address - Phone:954-473-9998
Mailing Address - Fax:954-262-3882
Practice Address - Street 1:3481 SOUTHERN ORCHARD RD E
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6962
Practice Address - Country:US
Practice Address - Phone:954-473-9998
Practice Address - Fax:954-262-3882
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD71141223P0106X
FLDTP3831223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT59631Medicare UPIN
FLU0336ZMedicare ID - Type Unspecified