Provider Demographics
NPI:1265890602
Name:SIEBKA SMILES MOBILE DENTAL HYGIENE SERVICES
Entity type:Organization
Organization Name:SIEBKA SMILES MOBILE DENTAL HYGIENE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIEBKA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, PHDHP,COA
Authorized Official - Phone:814-229-9494
Mailing Address - Street 1:357 OLEAN RD
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:PA
Mailing Address - Zip Code:15829-6415
Mailing Address - Country:US
Mailing Address - Phone:814-229-9494
Mailing Address - Fax:
Practice Address - Street 1:357 OLEAN RD
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:PA
Practice Address - Zip Code:15829-6415
Practice Address - Country:US
Practice Address - Phone:814-229-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068725124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty