Provider Demographics
NPI:1457368078
Name:SIEFKER, THOMAS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:SIEFKER
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 1:125 MAIN STREET
Mailing Address - Street 2:P O BOX 250
Mailing Address - City:OTTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45876-0250
Mailing Address - Country:US
Mailing Address - Phone:419-453-3000
Mailing Address - Fax:419-453-3001
Practice Address - Street 1:125 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OTTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45876-0250
Practice Address - Country:US
Practice Address - Phone:419-453-3000
Practice Address - Fax:419-453-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0188641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice