Provider Demographics
NPI:1205938826
Name:SIEWEKE, JOHN CLINTON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLINTON
Last Name:SIEWEKE
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 1:636 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4311
Mailing Address - Country:US
Mailing Address - Phone:770-639-2248
Mailing Address - Fax:
Practice Address - Street 1:PIKE PLAZA
Practice Address - Street 2:417 PLAZA DR.
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295-3029
Practice Address - Country:US
Practice Address - Phone:770-227-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice