Provider Demographics
NPI:1194939587
Name:SIROCKY, KENNETH M (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:SIROCKY
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 1:16360 PEARL ROAD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136
Mailing Address - Country:US
Mailing Address - Phone:440-238-2298
Mailing Address - Fax:440-846-4700
Practice Address - Street 1:16360 PEARL ROAD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-238-2298
Practice Address - Fax:440-846-4700
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist