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General NPI Number Information
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NPI Number | 1467138974
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Entity Type | Individual
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Provider Name | MITCHELL JUDAH SIEGELMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 07/01/2023
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Provider Practice Location Address
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Address Line | 573 CRANBURY RD STE A1
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4144
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Country | US
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Telephone | 732-613-1931
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Fax |
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Provider Business Mailing Address
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Address Line | 817 EVERGREEN CT
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2336
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Country | US
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Telephone | 732-543-5467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02978500
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License Number State | NJ
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