Provider Demographics
NPI:1699845024
Name:REBECCA SISCEL DDS PC
Entity Type:Organization
Organization Name:REBECCA SISCEL DDS PC
Other - Org Name:REBECCA SISCEL DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PICKENS
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:314-966-7707
Mailing Address - Street 1:139 WEST MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-966-7707
Mailing Address - Fax:314-966-9969
Practice Address - Street 1:139 WEST MONROE AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-966-7707
Practice Address - Fax:314-966-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty