Provider Demographics
NPI:1578676656
Name:SIEDLECKI, JODIE DAWN (DDS)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:DAWN
Last Name:SIEDLECKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2860
Mailing Address - Country:US
Mailing Address - Phone:440-886-1916
Mailing Address - Fax:440-885-7114
Practice Address - Street 1:5885 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2860
Practice Address - Country:US
Practice Address - Phone:440-886-1916
Practice Address - Fax:440-885-7114
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist