Provider Demographics
NPI:1255396313
Name:SIERRA, GERMAN ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:ANTONIO
Last Name:SIERRA
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:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0780
Mailing Address - Country:US
Mailing Address - Phone:928-536-7158
Mailing Address - Fax:928-536-2640
Practice Address - Street 1:155 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5211
Practice Address - Country:US
Practice Address - Phone:928-536-7158
Practice Address - Fax:928-536-2640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
110375OtherPREMIER ACCESS
4607OtherDELTA DENTAL
AZ0489570OtherBCBS
UC991320OtherUNITED CONCORDIA