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General NPI Number Information
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NPI Number | 1104186865
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Entity Type | Individual
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Provider Name | NICHOLAS PATRICK SIROIS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 60 LOWELL ST
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City | RUMFORD
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State | ME
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Zip | 04276-2064
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Country | US
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Telephone | 207-369-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BRUNSWICK TER
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City | GARDINER
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State | ME
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Zip | 04345-2429
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Country | US
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Telephone | 207-798-9268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4242
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License Number State | ME
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