Individual
DR. KATIE PARK SIEGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11246 SULLIVAN ST, RIVERVIEW, FL 33578-2140
(813) 530-0111
Mailing address
10623 CARDERA DR, RIVERVIEW, FL 33578-4705
(443) 883-6402
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN26203
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2020
Last updated
10/19/2023
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