Provider Demographics
NPI:1285747212
Name:SIEGEL, VICTOR ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ROBERT
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16815 CRABBS BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2215
Mailing Address - Country:US
Mailing Address - Phone:301-963-4330
Mailing Address - Fax:301-963-3429
Practice Address - Street 1:16815 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2215
Practice Address - Country:US
Practice Address - Phone:301-963-4330
Practice Address - Fax:301-963-3429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice