Provider Demographics
NPI:1649859695
Name:SIROTNIKOV, BRIAN ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:SIROTNIKOV
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 1:2249 OCEAN AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2305
Mailing Address - Country:US
Mailing Address - Phone:917-626-5607
Mailing Address - Fax:
Practice Address - Street 1:2415 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4982
Practice Address - Country:US
Practice Address - Phone:718-416-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0624891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice