Provider Demographics
NPI:1134600984
Name:SIBIRTSEV, ILONA (DDS)
Entity type:Individual
Prefix:DR
First Name:ILONA
Middle Name:
Last Name:SIBIRTSEV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 JEFFERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2400
Mailing Address - Country:US
Mailing Address - Phone:757-873-3407
Mailing Address - Fax:757-873-2565
Practice Address - Street 1:11713 JEFFERSON AVE
Practice Address - Street 2:STE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2400
Practice Address - Country:US
Practice Address - Phone:757-873-3407
Practice Address - Fax:757-873-2565
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014168111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice