Provider Demographics
NPI:1538655105
Name:SIROIS, MICAL (DMD)
Entity Type:Individual
Prefix:MISS
First Name:MICAL
Middle Name:
Last Name:SIROIS
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 1:535 45TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1347
Mailing Address - Country:US
Mailing Address - Phone:917-618-5921
Mailing Address - Fax:
Practice Address - Street 1:5008 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2167
Practice Address - Country:US
Practice Address - Phone:718-210-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program