Provider Demographics
NPI:1699720623
Name:SIBICK, EUGENE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MICHAEL
Last Name:SIBICK
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 1:6600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5933
Mailing Address - Country:US
Mailing Address - Phone:716-634-1234
Mailing Address - Fax:
Practice Address - Street 1:6600 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5933
Practice Address - Country:US
Practice Address - Phone:716-634-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040322-011223G0001X, 122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040322OtherNEW YORK DEPARTMENT OF EDUCATION
NY040322OtherNEW YORK DEPARTMENT OF EDUCATION