Provider Demographics
NPI:1083107874
Name:SIPIOR, JONATHAN M (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:SIPIOR
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:987 R C HOAG DR
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1365
Mailing Address - Country:US
Mailing Address - Phone:716-945-5894
Mailing Address - Fax:716-242-6344
Practice Address - Street 1:275 THOMAS INDIAN SCHOOL DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9341
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:716-242-6344
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0611701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000558119001-002OtherBCBS
NY06215214Medicaid