Provider Demographics
NPI:1992816284
Name:SIROTNAK, JAMES (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SIROTNAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1147
Mailing Address - Country:US
Mailing Address - Phone:570-489-2101
Mailing Address - Fax:
Practice Address - Street 1:400 DUNMORE ST
Practice Address - Street 2:
Practice Address - City:THROOP
Practice Address - State:PA
Practice Address - Zip Code:18512-1147
Practice Address - Country:US
Practice Address - Phone:570-489-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027651L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist