Provider Demographics
NPI:1801818034
Name:SIEFKER, JONATHAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:SIEFKER
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 1:217 DICKSON ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-1364
Mailing Address - Country:US
Mailing Address - Phone:440-647-2752
Mailing Address - Fax:440-647-1241
Practice Address - Street 1:217 DICKSON ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-1364
Practice Address - Country:US
Practice Address - Phone:440-647-2752
Practice Address - Fax:440-647-1241
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice