Provider Demographics
NPI:1275749467
Name:SILEGY, TIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:
Last Name:SILEGY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6226 E SPRING ST STE 315
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1449
Mailing Address - Country:US
Mailing Address - Phone:562-496-1978
Mailing Address - Fax:562-496-3228
Practice Address - Street 1:6226 E SPRING ST STE 315
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1449
Practice Address - Country:US
Practice Address - Phone:562-496-1978
Practice Address - Fax:562-496-3228
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery