Provider Demographics
NPI:1093915241
Name:JAMES SIROTNAK PC
Entity Type:Organization
Organization Name:JAMES SIROTNAK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROTNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-489-2101
Mailing Address - Street 1:400 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1147
Mailing Address - Country:US
Mailing Address - Phone:570-489-2101
Mailing Address - Fax:570-489-7227
Practice Address - Street 1:400 DUNMORE ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1147
Practice Address - Country:US
Practice Address - Phone:570-489-2101
Practice Address - Fax:570-489-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027651L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty