Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 08045 | IA |
Y | 1223P0221X | Pediatric Dentist | 8670 | CO |
NPI | 1093882870 |
---|---|
Provider Name | Jonathan David Sierk |
First Address | Highlands Ranch, CO 80130 |
Second Address | Highlands Ranch, CO 80130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |