MEDICARE: DR. STEVEN R SIERAKOWSKI DMD

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	1223P0300X	Periodontics	22DI02300400	NJ
2	1223P0300X	Periodontics	G1-0001284	DE
3	1223P0300X	Periodontics	DS036012	PA

General Provider Information

NPI Number	:	1508889387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN R SIERAKOWSKI DMD

Provider Business Mailing Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 100B
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	610-558-8283
Fax Number	:	610-558-9868

Provider Business Practice Location Address
First Line	:	1786 WILMINGTON W CHESTER PIKE STE 100B
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-8198
Country	:	US
Telephone Number	:	610-558-8283
Fax Number	:	610-558-9868

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/22/2021

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