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General NPI Number Information
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NPI Number | 1497825152
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Entity Type | Organization
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Legal Business Name | DEREK A SIEMON DDS LLC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 1833 G FOREST DR
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-263-7338
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Fax | 410-263-7339
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Provider Business Mailing Address
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Address Line | 1833 G FOREST DR
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City | ANNAPOLIS
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State | MD
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Zip | 21401
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Country | US
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Telephone | 410-263-7338
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Fax | 410-263-7339
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Authorized Official
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Title or Position | OWNER
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Name | DEREK A SIEMON
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Credential | DDS
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Telephone | 410-263-7338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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