Provider Demographics
NPI:1164004552
Name:SIBILLA, ANASTASIA (DDS)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:SIBILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANASTASIIA
Other - Middle Name:
Other - Last Name:SIBILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 MORRIS ST APT 1226
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4592
Mailing Address - Country:US
Mailing Address - Phone:646-379-1348
Mailing Address - Fax:
Practice Address - Street 1:418 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3101
Practice Address - Country:US
Practice Address - Phone:201-499-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL255971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice