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General NPI Number Information
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NPI Number | 1730667601
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Entity Type | Organization
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Legal Business Name | J. SIDERMAN DDS A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 9202 ALONDRA BLVD
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City | BELLFLOWER
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State | CA
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Zip | 90706-4210
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Country | US
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Telephone | 562-246-9989
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Fax | 562-263-9667
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Provider Business Mailing Address
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Address Line | 9202 ALONDRA BLVD
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City | BELLFLOWER
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State | CA
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Zip | 90706-4210
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Country | US
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Telephone | 562-246-9989
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Fax | 562-263-9667
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Authorized Official
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Title or Position | OWNER
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Name | JERRY SIDERMAN
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Credential | DDS
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Telephone | 562-246-9989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 41789
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License Number State | CA
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