Provider Demographics
NPI:1295849875
Name:JUSTINIANO, SANDRA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:JUSTINIANO
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 1:117 CALLE DE DIEGO ESTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-652-3502
Mailing Address - Fax:787-652-4306
Practice Address - Street 1:117 CALLE DE DIEGO ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-652-3502
Practice Address - Fax:787-652-4306
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL175101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics