Provider Demographics
NPI:1447632658
Name:SIKORA FAMILY DENTISTRY
Entity type:Organization
Organization Name:SIKORA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GANGIDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-779-8730
Mailing Address - Street 1:23755 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2260
Mailing Address - Country:US
Mailing Address - Phone:440-779-8730
Mailing Address - Fax:440-777-5896
Practice Address - Street 1:23755 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2260
Practice Address - Country:US
Practice Address - Phone:440-779-8730
Practice Address - Fax:440-777-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty