MEDICARE: GREGORY V SIERMINSKI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19015910	IL

General Provider Information

NPI Number	:	1255386801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY V SIERMINSKI DDS

Provider Business Mailing Address
First Line	:	7442 HANCOCK DR
Second Line	:
City	:	WONDER LAKE
State	:	IL
Zip	:	60097
Country	:	US
Telephone Number	:	815-728-0100
Fax Number	:	815-728-0114

Provider Business Practice Location Address
First Line	:	7442 HANCOCK DR
Second Line	:
City	:	WONDER LAKE
State	:	IL
Zip	:	60097
Country	:	US
Telephone Number	:	815-728-0100
Fax Number	:	815-728-0114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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