Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 061170 | NY |
NPI | 1083107874 |
---|---|
Provider Name | Jonathan M Sipior |
First Address | Buffalo, NY 14214-8006 |
Second Address | Rochester, NY 14617-5107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 29/08/2020 |