Provider Demographics
NPI:1154477263
Name:SINIAVER, ELENA (DMD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SINIAVER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4077
Mailing Address - Country:US
Mailing Address - Phone:855-745-0055
Mailing Address - Fax:978-745-0058
Practice Address - Street 1:90 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4077
Practice Address - Country:US
Practice Address - Phone:855-745-0055
Practice Address - Fax:978-745-0058
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110008216AMedicaid