Provider Demographics
NPI:1114365970
Name:SAYOC, AGERICO M
Entity Type:Individual
Prefix:
First Name:AGERICO
Middle Name:M
Last Name:SAYOC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13167 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3125
Mailing Address - Country:US
Mailing Address - Phone:904-221-0054
Mailing Address - Fax:904-221-0049
Practice Address - Street 1:13167 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3125
Practice Address - Country:US
Practice Address - Phone:904-221-0054
Practice Address - Fax:904-221-0049
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN108311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics