Provider Demographics
NPI:1558396150
Name:SIEGRIST, G. BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:BRYAN
Last Name:SIEGRIST
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 1:965 S COLORADO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2405
Mailing Address - Country:US
Mailing Address - Phone:303-871-9179
Mailing Address - Fax:303-871-0161
Practice Address - Street 1:965 S COLORADO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2405
Practice Address - Country:US
Practice Address - Phone:303-871-9179
Practice Address - Fax:303-871-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist