Individual
DR. BORIS J SIDOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3634 WHEELER ROAD, AUGUSTA, GA 30909-6518
(706) 860-8228
(706) 860-7222
Mailing address
3634 WHEELER ROAD, AUGUSTA, GA 30909-6518
(706) 860-8228
(706) 860-7222
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN013478
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013478
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111331508B
—
GA
Enumeration date
08/09/2006
Last updated
09/16/2015
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