Provider Demographics
NPI:1922034750
Name:SIEGAL, FREDERIC HOWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:HOWARD
Last Name:SIEGAL
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 1:1050 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2853
Mailing Address - Country:US
Mailing Address - Phone:610-543-2288
Mailing Address - Fax:610-543-3399
Practice Address - Street 1:1050 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2853
Practice Address - Country:US
Practice Address - Phone:610-543-2288
Practice Address - Fax:610-543-3399
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019265-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics