Provider Demographics
NPI:1740818848
Name:SIEGEL, JARED BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:BENJAMIN
Last Name:SIEGEL
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 1:205 S PEORIA ST APT 1219
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3129
Mailing Address - Country:US
Mailing Address - Phone:631-374-8567
Mailing Address - Fax:
Practice Address - Street 1:41 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1201
Practice Address - Country:US
Practice Address - Phone:219-336-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0329021223G0001X
IN12013641A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice