Provider Demographics
NPI:1679729586
Name:SIRECI, EDWARD M (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:SIRECI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 BRUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1965
Mailing Address - Country:US
Mailing Address - Phone:718-829-0455
Mailing Address - Fax:718-829-0825
Practice Address - Street 1:2861 BRUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1965
Practice Address - Country:US
Practice Address - Phone:718-829-0455
Practice Address - Fax:718-829-0825
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice