Provider Demographics
NPI:1740694504
Name:ROXANNE SIEGRIST DDS LLC
Entity type:Organization
Organization Name:ROXANNE SIEGRIST DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:SIEGRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-349-5577
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-0639
Mailing Address - Country:US
Mailing Address - Phone:970-349-5577
Mailing Address - Fax:970-349-5578
Practice Address - Street 1:507 RED LADY AVENUE
Practice Address - Street 2:SUITE 142
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-5577
Practice Address - Fax:970-349-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty