David Sim Siceloff, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

NC4114 Issued in NC

Practice address

19 E 2ND Ave
Lexington, NC 27292-3362

Phone

(336) 249-6524

Fax

(336) 238-1060

NPI assigned

Jan 15, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• D Sim Siceloff DDS PA

  • Dentist
  • Lexington, NC
  • NPI 1902983067
  NPD (past) Authorized official
• Londry & Modlin XII DDS PLLC

  • General Practice Dentistry
  • Lexington, NC
  • NPI 1821708041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1417294109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 E 2ND AVE",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272923362",
            "telephone_number": "336-249-6524",
            "fax_number": "336-238-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E 2ND AVE",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272923362",
            "telephone_number": "336-249-6524",
            "fax_number": "336-238-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SICELOFF",
        "first_name": "DAVID",
        "middle_name": "SIM",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "NC4114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "69343",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8997790",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "97790",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Sheppard, OTR/L
• Devam Pareshkumar Sheth, M.D.
• Freda Bailey Shipman, MSW, LCSW
• Amanda Brooke Shook, MS, CCC-SLP
• Daniel Simeon Siceloff, DDS
• Matthew David Sills, NCC, LPC
• Lois E Simmons, OTR/L
• Jeffrey Alan Simms, LCMHC
• Andrew Michael Simpson, O.D.
• Phouangboupha Sinouanthavysouk

• Dentist in Lexington, NC
• Providers in Lexington, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.