Provider Demographics
NPI:1003248824
Name:LAGO-SANCHEZ, IDELBIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IDELBIS
Middle Name:
Last Name:LAGO-SANCHEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7437 PINE TREE LN
Mailing Address - Street 2:LAKE CLARKE SHORES
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6820
Mailing Address - Country:US
Mailing Address - Phone:561-201-1713
Mailing Address - Fax:
Practice Address - Street 1:3729 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4033
Practice Address - Country:US
Practice Address - Phone:561-201-8078
Practice Address - Fax:561-584-7726
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009877200Medicaid