MEDICARE: JARED B SIEGEL DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1740818848	OTHER	IL	INSURANCE

General Provider Information

NPI Number	:	1073249769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JARED B SIEGEL DDS PC

Provider Business Mailing Address
First Line	:	3052 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4286
Country	:	US
Telephone Number	:	773-997-1979
Fax Number	:

Provider Business Practice Location Address
First Line	:	3052 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4286
Country	:	US
Telephone Number	:	773-997-1979
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JARED BENJAMIN SIEGEL
Credential	:	DDS
Telephone Number	:	631-374-8567

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	01/21/2025

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