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General NPI Number Information
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NPI Number | 1134600984
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Entity Type | Individual
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Provider Name | ILONA SIBIRTSEV DDS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 11713 JEFFERSON AVE STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2400
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Country | US
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Telephone | 757-873-3407
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Fax | 757-873-2565
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Provider Business Mailing Address
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Address Line | 11713 JEFFERSON AVE STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2400
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Country | US
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Telephone | 757-873-3407
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Fax | 757-873-2565
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416811
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License Number State | VA
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