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General NPI Number Information
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NPI Number | 1114325776
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Entity Type | Organization
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Legal Business Name | ANTHONY J. SIDOR, D.D.S., P.A.
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 225 S PLUMOSA ST
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3525
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Country | US
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Telephone | 321-453-1890
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Fax |
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Provider Business Mailing Address
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Address Line | 225 S PLUMOSA ST
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3525
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Country | US
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Telephone | 321-453-1890
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANTHONY JOHN SIDOR
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Credential | DDS
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Telephone | 321-453-1890
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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 | DN13170
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License Number State | FL
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