Provider Demographics
NPI:1265425987
Name:SEIBERT, STEVEN W (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:W
Other - Last Name:SEIBERT D.M.D., LTD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1804 BENTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-9218
Mailing Address - Country:US
Mailing Address - Phone:217-352-2711
Mailing Address - Fax:
Practice Address - Street 1:3002 CROSSING CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6135
Practice Address - Country:US
Practice Address - Phone:217-398-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210012611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA A F D E N 3 B B SOtherBLUE CROSS BLUE SHIELD IL
AL62113329OtherBLUE CROSS BLUE SHIELD AL
IL564197OtherUNITED CONCORDIA