Provider Demographics
NPI:1598044554
Name:SIELSKI, MACIEJ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:
Last Name:SIELSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:SIELSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8817 WHITE IBIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729
Mailing Address - Country:US
Mailing Address - Phone:847-736-2567
Mailing Address - Fax:
Practice Address - Street 1:16944 S. HIGHLAND AVE
Practice Address - Street 2:STE 400
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-275-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028784122300000X
TX30566122300000X
CA1014161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist