Provider Demographics
NPI:1578714796
Name:SIVIK, MICHAEL C (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:SIVIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6265
Mailing Address - Country:US
Mailing Address - Phone:440-992-3146
Mailing Address - Fax:440-998-6932
Practice Address - Street 1:5005 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6265
Practice Address - Country:US
Practice Address - Phone:440-992-3146
Practice Address - Fax:440-998-6932
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH229041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice