Provider Demographics
NPI:1477727378
Name:DAVID I SIEGAL ENTERPRISES INC
Entity Type:Organization
Organization Name:DAVID I SIEGAL ENTERPRISES INC
Other - Org Name:DAVID I SIEGAL DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-764-5318
Mailing Address - Street 1:2845 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:773-764-5318
Mailing Address - Fax:773-465-8101
Practice Address - Street 1:2845 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:773-764-5318
Practice Address - Fax:773-465-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty