Provider Demographics
NPI:1053410050
Name:SIEGEL, STUART BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:BRIAN
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 1:2915 E CERVANTES ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6418
Mailing Address - Country:US
Mailing Address - Phone:850-435-3111
Mailing Address - Fax:850-435-3198
Practice Address - Street 1:2915 E CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6418
Practice Address - Country:US
Practice Address - Phone:850-435-3111
Practice Address - Fax:850-435-3198
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL6143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0777595Medicaid