Provider Demographics
NPI:1114681939
Name:RAISKI, SIDNEY ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:ADAM
Last Name:RAISKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SIDNEY
Other - Middle Name:
Other - Last Name:RAISKI-WILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:108 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-1245
Mailing Address - Country:US
Mailing Address - Phone:407-227-8605
Mailing Address - Fax:
Practice Address - Street 1:129 MA-28
Practice Address - Street 2:
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671
Practice Address - Country:US
Practice Address - Phone:508-255-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist