Provider Demographics
NPI:1497732945
Name:SIEGEL, JUSTIN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
Last Name:SIEGEL
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 1:12 PINETREE DR
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3335
Mailing Address - Country:US
Mailing Address - Phone:914-962-8149
Mailing Address - Fax:
Practice Address - Street 1:1983 ROUTE 52
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3524
Practice Address - Country:US
Practice Address - Phone:845-896-7788
Practice Address - Fax:845-896-7879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist