Healthcare Provider Details

I. General information

NPI: 1770555153
Provider Name (Legal Business Name): IRA PAUL SY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 260-6180 BLUNDELL ROAD
RICHMOND BRITISH COLUMBIA
V7C 4W7
CA

IV. Provider business mailing address

6091 BARNARD DRIVE
RICHMOND BRITISH COLUMBIA
V7C 5N5
CA

V. Phone/Fax

Practice location:
  • Phone: 604-271-4867
  • Fax: 604-271-4865
Mailing address:
  • Phone: 778-882-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS030678L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: