Healthcare Provider Details

I. General information

NPI: 1225749948
Provider Name (Legal Business Name): SIRA DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 MAIN ST
SPOTSWOOD NJ
08884-1702
US

IV. Provider business mailing address

2 ADAM CT
MONROE NJ
08831-0169
US

V. Phone/Fax

Practice location:
  • Phone: 732-334-8102
  • Fax:
Mailing address:
  • Phone: 732-589-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MASSOUD
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 732-454-7472