Provider Demographics
NPI:1255476800
Name:SIEGAL, JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:SIEGAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 SPRUCE DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2217
Mailing Address - Country:US
Mailing Address - Phone:908-233-4422
Mailing Address - Fax:908-233-8242
Practice Address - Street 1:1132 SPRUCE DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2217
Practice Address - Country:US
Practice Address - Phone:908-233-4422
Practice Address - Fax:908-233-8242
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ159361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice