Provider Demographics
NPI:1891701371
Name:SIAO, KEVIN C (DMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:SIAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3322
Mailing Address - Country:US
Mailing Address - Phone:954-474-4111
Mailing Address - Fax:954-474-4584
Practice Address - Street 1:1125 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3322
Practice Address - Country:US
Practice Address - Phone:954-474-4111
Practice Address - Fax:954-474-4584
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 143801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice