Provider Demographics
NPI:1609143593
Name:SIEGRIST, ROXANNE CATHERINE
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:CATHERINE
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:CATHERINE
Other - Last Name:RUDOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-0639
Mailing Address - Country:US
Mailing Address - Phone:970-349-5577
Mailing Address - Fax:
Practice Address - Street 1:507 RED LADY AVENUE
Practice Address - Street 2:SUITE 142
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3852122300000X
CO202159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist