Provider Demographics
NPI:1538102785
Name:SANDIFER, JOHNNY BOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:BOYD
Last Name:SANDIFER
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 1:710 LAKE CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5539
Mailing Address - Country:US
Mailing Address - Phone:843-270-2106
Mailing Address - Fax:843-792-7809
Practice Address - Street 1:234 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1612
Practice Address - Country:US
Practice Address - Phone:407-428-1672
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics