Provider Demographics
NPI:1760776934
Name:SIEGERT, JACOB JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JAMES
Last Name:SIEGERT
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 1:4131 26TH ST NW
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8342
Mailing Address - Country:US
Mailing Address - Phone:507-282-8082
Mailing Address - Fax:
Practice Address - Street 1:4131 26TH ST NW
Practice Address - Street 2:SUITE #1
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8342
Practice Address - Country:US
Practice Address - Phone:507-282-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist