Provider Demographics
NPI:1366136830
Name:SIEGEL, BRETT ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLEN
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:ALLEN
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BRETT SIEGEL DDS
Mailing Address - Street 1:441 E MAIN ST # VA20132
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3170
Mailing Address - Country:US
Mailing Address - Phone:540-338-7325
Mailing Address - Fax:540-338-9117
Practice Address - Street 1:441 E MAIN ST # VA20132
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3170
Practice Address - Country:US
Practice Address - Phone:540-338-7325
Practice Address - Fax:540-338-9117
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist