Healthcare Provider Details

I. General information

NPI: 1659653772
Provider Name (Legal Business Name): SAMANTHA SIEBENECK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E MAIN ST
COLUMBUS OH
43205-1902
US

IV. Provider business mailing address

3433 AGLER RD STE 2800
COLUMBUS OH
43219-3389
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-5535
  • Fax:
Mailing address:
  • Phone: 614-859-1906
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-023572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: