Provider Demographics
NPI:1780755819
Name:SIEFFERMAN, STEPHEN BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRIAN
Last Name:SIEFFERMAN
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 1:12500 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2049
Mailing Address - Country:US
Mailing Address - Phone:708-671-0887
Mailing Address - Fax:708-671-0889
Practice Address - Street 1:12500 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2049
Practice Address - Country:US
Practice Address - Phone:708-671-0887
Practice Address - Fax:708-671-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice