Active NPI
Michael Anthony Siy, DDS
- Periodontics
- Bethesda, MD
National Provider Identifier
1255855904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12879938-9923
- Practice address
- 8955 Wood Rd
Bethesda, MD 20889-3037 - Phone
- (559) 313-5858
- NPI assigned
- Aug 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS101595 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Periodontics | 1223P0300X | 12879938-9923 | UT | Primary |
Addresses
Primary practice location
8955 Wood Rd
Bethesda, MD 20889-3037
Mailing address
11800 Old Georgetown Rd Unit 1120
Rockville, MD 20852-2647
Other practice location 1
BLDG 6905 Harris Ave
MCBH Kaneohe Bay
Kailua, HI 96863-3037
Phone (559) 313-5858
Other practice location 2
Naval Hospital Camp Pendleton
200 Mercy Circle Box 555191
Camp Pendleton, CA 92055
Phone (760) 719-3675
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD0000 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS101595 | CA | MD | Dentist |
| 12879938-9923 | UT | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1255855904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11800 OLD GEORGETOWN RD UNIT 1120",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208522647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8955 WOOD RD",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208893037",
"telephone_number": "559-313-5858"
}
],
"practiceLocations": [
{
"address_1": "BLDG 6905 Harris Ave",
"address_2": "MCBH KANEOHE BAY",
"address_purpose": "LOCATION",
"city": "Kailua",
"state": "HI",
"postal_code": "968633037",
"country_code": "US",
"telephone_number": "559-313-5858",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Naval Hospital Camp Pendleton",
"address_2": "200 Mercy Circle Box 555191",
"address_purpose": "LOCATION",
"city": "Camp Pendleton",
"state": "CA",
"postal_code": "92055",
"country_code": "US",
"telephone_number": "760-719-3675",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SIY",
"first_name": "MICHAEL",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-02",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS101595",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "UT",
"license": "12879938-9923",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "VAD0000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.