Provider Demographics
NPI:1811210560
Name:SIEGEL, SUSAN R (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 HENRY HUDSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1326
Mailing Address - Country:US
Mailing Address - Phone:718-796-2500
Mailing Address - Fax:718-548-7858
Practice Address - Street 1:3515 HENRY HUDSON PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1326
Practice Address - Country:US
Practice Address - Phone:718-796-2500
Practice Address - Fax:718-548-7858
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist