Healthcare Provider Details

I. General information

NPI: 1124395652
Provider Name (Legal Business Name): STEVEN MARC SIEGEL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 CRAIN HWY S
GLEN BURNIE MD
21061-4934
US

IV. Provider business mailing address

7935 CRAIN HWY S
GLEN BURNIE MD
21061-4934
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-6960
  • Fax: 410-761-8709
Mailing address:
  • Phone: 410-761-6960
  • Fax: 410-761-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: