Provider Demographics
NPI:1033520770
Name:SIEHOFF, MARIELA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:SIEHOFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 W HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2042
Mailing Address - Country:US
Mailing Address - Phone:414-321-2720
Mailing Address - Fax:414-321-7718
Practice Address - Street 1:10202 W HAYES AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2042
Practice Address - Country:US
Practice Address - Phone:414-321-2720
Practice Address - Fax:414-321-7718
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7237-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice