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General NPI Number Information
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NPI Number | 1265890602
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Entity Type | Organization
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Legal Business Name | SIEBKA SMILES MOBILE DENTAL HYGIENE SERVICES
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Dates
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Enumeration Date | 01/31/2016
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Last Update Date | 01/31/2016
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Provider Practice Location Address
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Address Line | 357 OLEAN RD
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City | CORSICA
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State | PA
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Zip | 15829-6415
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Country | US
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Telephone | 814-229-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 357 OLEAN RD
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City | CORSICA
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State | PA
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Zip | 15829-6415
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Country | US
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Telephone | 814-229-9494
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. CRYSTAL K SIEBKA
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Credential | RDH, PHDHP,COA
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Telephone | 814-229-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH068725
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License Number State | PA
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