Provider Demographics
NPI:1063744159
Name:SIEGEL, GINA M (DDS)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:CAVARETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4575 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4567
Practice Address - Country:US
Practice Address - Phone:716-839-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045688-11223E0200X
NY04568811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics