Healthcare Provider Details

I. General information

NPI: 1487834438
Provider Name (Legal Business Name): SCOTT LEWIS SIEGEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5867 N MESA ST STE B
EL PASO TX
79912-4678
US

IV. Provider business mailing address

8713 SEVANO CIR NE
ALBUQUERQUE NM
87113-2494
US

V. Phone/Fax

Practice location:
  • Phone: 915-504-6888
  • Fax:
Mailing address:
  • Phone: 512-787-7174
  • Fax: 505-916-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDD2955
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number24336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: