Provider Demographics
NPI:1679734727
Name:SIFFRARD, VENIS FILS (DDS)
Entity Type:Individual
Prefix:DR
First Name:VENIS
Middle Name:FILS
Last Name:SIFFRARD
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 1:6760 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7056
Mailing Address - Country:US
Mailing Address - Phone:662-895-3000
Mailing Address - Fax:662-895-3021
Practice Address - Street 1:6760 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8778
Practice Address - Country:US
Practice Address - Phone:662-895-3000
Practice Address - Fax:662-895-3021
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice