Provider Demographics
NPI:1548612047
Name:SIDRYS, VINCAS (DMD)
Entity Type:Individual
Prefix:
First Name:VINCAS
Middle Name:
Last Name:SIDRYS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:VINCAS
Other - Middle Name:V
Other - Last Name:SIDRYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PLLC
Mailing Address - Street 1:5000 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4642
Mailing Address - Country:US
Mailing Address - Phone:540-769-6370
Mailing Address - Fax:540-769-6373
Practice Address - Street 1:5000 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4642
Practice Address - Country:US
Practice Address - Phone:540-769-6370
Practice Address - Fax:540-769-6373
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030817122300000X
NC105671223G0001X
VA04014173891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist