MEDICARE: DR. YURI SIROTINSKI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	011079	CT

General Provider Information

NPI Number	:	1265863559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YURI SIROTINSKI D.D.S.

Provider Business Mailing Address
First Line	:	25 OAK RIDGE GATE
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2667
Country	:	US
Telephone Number	:	860-313-0025
Fax Number	:	860-313-0301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	12/11/2013

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