Healthcare Provider Details

I. General information

NPI: 1689246829
Provider Name (Legal Business Name): NICHOLAS M SEIGEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ANNA AVENE
BLANDON PA
19510
US

IV. Provider business mailing address

PO BOX 260
BLANDON PA
19510-0260
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-1233
  • Fax: 610-916-7640
Mailing address:
  • Phone: 610-926-1233
  • Fax: 610-916-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS043192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: