Provider Demographics
NPI:1750275491
Name:SIEGFORD, TYLER ROSS (DDS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ROSS
Last Name:SIEGFORD
Suffix:
Gender:M
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:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-1389
Mailing Address - Country:US
Mailing Address - Phone:208-623-6400
Mailing Address - Fax:208-623-6464
Practice Address - Street 1:6070 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869-7742
Practice Address - Country:US
Practice Address - Phone:208-623-6400
Practice Address - Fax:208-623-6464
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID82719661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice