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General NPI Number Information
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NPI Number | 1750275491
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Entity Type | Individual
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Provider Name | TYLER ROSS SIEGFORD DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 6070 W JACKSON ST
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City | SPIRIT LAKE
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State | ID
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Zip | 83869-7742
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Country | US
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Telephone | 208-623-6400
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Fax | 208-623-6464
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Provider Business Mailing Address
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Address Line | PO BOX 1389
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City | SPIRIT LAKE
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State | ID
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Zip | 83869-1389
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Country | US
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Telephone | 208-623-6400
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Fax | 208-623-6464
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8271966
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License Number State | ID
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