Provider Demographics
NPI:1699807362
Name:SIA N. HERSINI, DMD, PC
Entity Type:Organization
Organization Name:SIA N. HERSINI, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERSINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-789-9054
Mailing Address - Street 1:404 WILLIAM ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2143
Mailing Address - Country:US
Mailing Address - Phone:315-789-9054
Mailing Address - Fax:315-781-1297
Practice Address - Street 1:404 WILLIAM ST
Practice Address - Street 2:SUITE D
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2143
Practice Address - Country:US
Practice Address - Phone:315-789-9054
Practice Address - Fax:315-781-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146138Medicaid