MEDICARE: DR. ROBERT I SIROTNIK D.D.S.

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	1223G0001X	General Practice Dentistry	24503	CA

General Provider Information

NPI Number	:	1881699155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT I SIROTNIK D.D.S.

Provider Business Mailing Address
First Line	:	4191 RIVERVIEW DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6616
Country	:	US
Telephone Number	:	951-683-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4191 RIVERVIEW DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6616
Country	:	US
Telephone Number	:	951-683-0333
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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