MEDICARE: DR. BRIAN ANTHONY SIROTNIKOV DDS

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	1223G0001X	General Practice Dentistry	062489	NY

General Provider Information

NPI Number	:	1649859695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ANTHONY SIROTNIKOV DDS

Provider Business Mailing Address
First Line	:	2249 OCEAN AVE APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2305
Country	:	US
Telephone Number	:	917-626-5607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4982
Country	:	US
Telephone Number	:	718-416-6444
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	07/25/2022

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