Provider Demographics
NPI:1720410632
Name:SIEGER, REBECCA L (DMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:SIEGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3054
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-3054
Mailing Address - Country:US
Mailing Address - Phone:516-359-7890
Mailing Address - Fax:631-537-1560
Practice Address - Street 1:384 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975-2000
Practice Address - Country:US
Practice Address - Phone:631-537-6364
Practice Address - Fax:631-537-0703
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist