Provider Demographics
NPI:1427467802
Name:SIEGEL, MATTHEW JONATHAN (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JONATHAN
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 1:2592 MERRICK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5742
Mailing Address - Country:US
Mailing Address - Phone:516-781-9700
Mailing Address - Fax:516-781-1936
Practice Address - Street 1:2592 MERRICK RD
Practice Address - Street 2:SUITE C
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5742
Practice Address - Country:US
Practice Address - Phone:516-781-9700
Practice Address - Fax:516-781-1936
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 057441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist