MEDICARE: DR. DONALD JOSEPH SIRIANNI DMD

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	D3991	OR

General Provider Information

NPI Number	:	1407027527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD JOSEPH SIRIANNI DMD

Provider Business Mailing Address
First Line	:	11320 SE LENORE ST
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-2732
Country	:	US
Telephone Number	:	503-698-7748
Fax Number	:	503-698-6765

Provider Business Practice Location Address
First Line	:	6969 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2103
Country	:	US
Telephone Number	:	503-654-8283
Fax Number	:	503-698-6765

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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