Provider Demographics
NPI:1023222858
Name:SIERK ORTHODONTICS, PC
Entity type:Organization
Organization Name:SIERK ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIERK
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMS
Authorized Official - Phone:563-359-8211
Mailing Address - Street 1:1918 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3292
Mailing Address - Country:US
Mailing Address - Phone:563-359-8211
Mailing Address - Fax:563-359-5710
Practice Address - Street 1:1918 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3292
Practice Address - Country:US
Practice Address - Phone:563-359-8211
Practice Address - Fax:563-359-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA58231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty