Provider Demographics
NPI:1336883685
Name:SICAIROS, ANAYS G (RDH)
Entity Type:Individual
Prefix:
First Name:ANAYS
Middle Name:G
Last Name:SICAIROS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANAYS
Other - Middle Name:G
Other - Last Name:SICAIROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:334 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9587
Mailing Address - Country:US
Mailing Address - Phone:209-262-0391
Mailing Address - Fax:
Practice Address - Street 1:600 B ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-9593
Practice Address - Country:US
Practice Address - Phone:209-850-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34682124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist