Healthcare Provider Details

I. General information

NPI: 1689372161
Provider Name (Legal Business Name): MERISA CIRIKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

V. Phone/Fax

Practice location:
  • Phone: 585-974-5045
  • Fax:
Mailing address:
  • Phone: 585-974-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: