Healthcare Provider Details

I. General information

NPI: 1053479709
Provider Name (Legal Business Name): CLEOPATRA SIORIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FLETCHER ST
GOSHEN NY
10924-1402
US

IV. Provider business mailing address

PO BOX 198
JEFFERSON VALLEY NY
10535-0198
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-8806
  • Fax: 845-294-8650
Mailing address:
  • Phone: 203-770-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: