Provider Demographics
NPI:1487882379
Name:SIEGEL, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAR
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:29777 TELEGRAPH RD
Mailing Address - Street 2:STE 3000
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7634
Mailing Address - Country:US
Mailing Address - Phone:248-430-4358
Mailing Address - Fax:
Practice Address - Street 1:1194 HILLSBORO MILE
Practice Address - Street 2:APT 56
Practice Address - City:HILLSBORO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1531
Practice Address - Country:US
Practice Address - Phone:561-252-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist