Provider Demographics
NPI:1811926645
Name:SIEGEL, MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
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 1:4287 FOXTAIL LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3841
Mailing Address - Country:US
Mailing Address - Phone:954-888-9041
Mailing Address - Fax:
Practice Address - Street 1:9873 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6100
Practice Address - Country:US
Practice Address - Phone:954-443-3030
Practice Address - Fax:954-443-9431
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL162171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry