Provider Demographics
NPI:1053368282
Name:SIEGEL, RICHARD DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
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 1:15833 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1203
Mailing Address - Country:US
Mailing Address - Phone:954-443-3030
Mailing Address - Fax:954-443-9431
Practice Address - Street 1:15833 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1203
Practice Address - Country:US
Practice Address - Phone:954-443-3030
Practice Address - Fax:954-443-9431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5054OtherDENTAL LICENCE