=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518771104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JON P SIPOS DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19004 BIRCH RD
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33967-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-267-3232
-----------------------------------------------------
Fax | 239-842-2066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19004 BIRCH RD
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33967-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-267-3232
-----------------------------------------------------
Fax | 239-842-2066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AARON JON SIPOS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 239-267-3232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------