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General NPI Number Information
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NPI Number | 1174026264
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Entity Type | Organization
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Legal Business Name | SIRI K. ZIESE DDS INC.
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1008 FOWLER WAY STE A
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City | PLACERVILLE
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State | CA
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Zip | 95667-5701
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Country | US
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Telephone | 530-622-2862
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Fax | 530-622-2072
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Provider Business Mailing Address
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Address Line | 1008 FOWLER WAY STE A
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City | PLACERVILLE
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State | CA
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Zip | 95667-5701
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Country | US
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Telephone | 530-622-2862
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Fax | 530-622-2072
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Authorized Official
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Title or Position | DENTIST
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Name | SIRI KATE ZIESE
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Credential | DDS
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Telephone | 530-622-2862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D56147
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License Number State | CA
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