Mark Sidransky, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN.00204390 Issued in CO

Practice address

59 DG Af Postgraduate Dental School
2133 Pepperrell Street, Building 3352
Jbsa Lackland, TX 78236-5313

Phone

(210) 292-6258

NPI assigned

Jun 5, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1760006670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 DOOLITTLE AVE UNIT FORT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761271133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 DG AF POSTGRADUATE DENTAL SCHOOL",
            "address_2": "2133 PEPPERRELL STREET, BUILDING 3352",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDRANSKY",
        "first_name": "MARK",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-05",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00204390",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00204390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dmitry Sher, D.C.
• Ryan Richard Sheridan, D.M.D
• Paul Michael Sherman, M.D.
• James E Shields, PT, DPT, OCS
• Evan Shipp
• Steven Siemieniak, DO
• Dustin Simpson, M.D.
• Kathryn C Simpson, MD
• Derek John Skousen, DDS
• Aileen Smith

• General Practice Dentistry in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.