Provider Demographics
NPI:1295995850
Name:SIEGRIST, JENNA LYN (RDH)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LYN
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NORTH RD
Mailing Address - Street 2:APT#3
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1016
Mailing Address - Country:US
Mailing Address - Phone:607-761-6373
Mailing Address - Fax:
Practice Address - Street 1:39 NORTH RD APT 3
Practice Address - Street 2:APT#3
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1016
Practice Address - Country:US
Practice Address - Phone:607-761-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024269-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist