Healthcare Provider Details

I. General information

NPI: 1285747212
Provider Name (Legal Business Name): VICTOR ROBERT SIEGEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 CRABBS BRANCH WAY
ROCKVILLE MD
20855-2215
US

IV. Provider business mailing address

16815 CRABBS BRANCH WAY
ROCKVILLE MD
20855-2215
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-4330
  • Fax: 301-963-3429
Mailing address:
  • Phone: 301-963-4330
  • Fax: 301-963-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: