Healthcare Provider Details

I. General information

NPI: 1891069183
Provider Name (Legal Business Name): STEVEN SIRIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRESCENT ST
ELGIN IL
60123-6267
US

IV. Provider business mailing address

1 CRESCENT ST
ELGIN IL
60123-6267
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-1330
  • Fax:
Mailing address:
  • Phone: 847-742-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number060-010331
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN RAEL SIRIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 847-742-1330