Provider Demographics
NPI:1033354543
Name:SIRECI FAMILY DENTAL PC
Entity Type:Organization
Organization Name:SIRECI FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIRECI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-829-0455
Mailing Address - Street 1:2861 BRUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1965
Mailing Address - Country:US
Mailing Address - Phone:718-829-0455
Mailing Address - Fax:718-829-0825
Practice Address - Street 1:2861 BRUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1965
Practice Address - Country:US
Practice Address - Phone:718-829-0455
Practice Address - Fax:718-829-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036511261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental