Provider Demographics
NPI:1376994236
Name:SANCHEZ, JAIRO ANDRES (DMD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:ANDRES
Last Name:SANCHEZ
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 1:9070 KIMBERLY BLVD STE 60
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2861
Mailing Address - Country:US
Mailing Address - Phone:561-571-6102
Mailing Address - Fax:
Practice Address - Street 1:9070 KIMBERLY BLVD STE 60
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2861
Practice Address - Country:US
Practice Address - Phone:561-571-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22032122300000X
FLDN 22032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist