Provider Demographics
NPI:1255855904
Name:SIY, MICHAEL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SIY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 N ARCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2331
Mailing Address - Country:US
Mailing Address - Phone:559-313-5858
Mailing Address - Fax:
Practice Address - Street 1:BLDG 6905 HARRIS AVE
Practice Address - Street 2:MCBH KANEOHE BAY
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96863-3037
Practice Address - Country:US
Practice Address - Phone:559-313-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS101595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicaid