Provider Demographics
NPI:1467138974
Name:SIEGELMAN, MITCHELL JUDAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JUDAH
Last Name:SIEGELMAN
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 1:817 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2336
Mailing Address - Country:US
Mailing Address - Phone:732-543-5467
Mailing Address - Fax:
Practice Address - Street 1:573 CRANBURY RD STE A1
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4144
Practice Address - Country:US
Practice Address - Phone:732-613-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02978500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist