Provider Demographics
NPI:1013024397
Name:SAYAF, KONSTANTINE N/A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINE
Middle Name:N/A
Last Name:SAYAF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N LOMBARDY LOOP
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5268
Mailing Address - Country:US
Mailing Address - Phone:904-307-0767
Mailing Address - Fax:904-387-5109
Practice Address - Street 1:1147 EDGEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-0810
Practice Address - Country:US
Practice Address - Phone:904-388-1421
Practice Address - Fax:904-387-5109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice