MEDICARE: DR. SCOTT GRAHAM SIEMEN D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17973	MA

General Provider Information

NPI Number	:	1316093354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT GRAHAM SIEMEN D.M.D

Provider Business Mailing Address
First Line	:	672 PLEASANT ST
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1306
Country	:	US
Telephone Number	:	508-791-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 PLEASANT ST
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1306
Country	:	US
Telephone Number	:	508-557-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	05/04/2020

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