Provider Demographics
NPI:1104186865
Name:SIROIS, NICHOLAS PATRICK (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PATRICK
Last Name:SIROIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRUNSWICK TER
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2429
Mailing Address - Country:US
Mailing Address - Phone:207-798-9268
Mailing Address - Fax:
Practice Address - Street 1:60 LOWELL ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2064
Practice Address - Country:US
Practice Address - Phone:207-369-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist