Provider Demographics
NPI:1184929028
Name:RICHARD A. SIEGEL
Entity type:Organization
Organization Name:RICHARD A. SIEGEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-436-3296
Mailing Address - Street 1:4574 MORSE CENTRE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6602
Mailing Address - Country:US
Mailing Address - Phone:614-436-3296
Mailing Address - Fax:614-436-3486
Practice Address - Street 1:4574 MORSE CENTRE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6602
Practice Address - Country:US
Practice Address - Phone:614-436-3296
Practice Address - Fax:614-436-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty