Provider Demographics
NPI:1285736801
Name:JOHN C. SIEWEKE, DDS, PC
Entity type:Organization
Organization Name:JOHN C. SIEWEKE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIEWEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-786-2754
Mailing Address - Street 1:3218 MILL ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2538
Mailing Address - Country:US
Mailing Address - Phone:770-786-2754
Mailing Address - Fax:770-786-2711
Practice Address - Street 1:3218 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2538
Practice Address - Country:US
Practice Address - Phone:770-786-2754
Practice Address - Fax:770-786-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty