Provider Demographics
NPI:1275938581
Name:JOSEPH SIRAGUSA, DDS,PC
Entity Type:Organization
Organization Name:JOSEPH SIRAGUSA, DDS,PC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAGUSA
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-826-3636
Mailing Address - Street 1:2114 HARTFORD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2409
Mailing Address - Country:US
Mailing Address - Phone:757-826-3636
Mailing Address - Fax:757-826-1316
Practice Address - Street 1:2114 HARTFORD RD
Practice Address - Street 2:SUITE B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2409
Practice Address - Country:US
Practice Address - Phone:757-826-3636
Practice Address - Fax:757-826-1316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty