Provider Demographics
NPI:1578005179
Name:SEDENO, EDDY JUAN III (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:JUAN
Last Name:SEDENO
Suffix:III
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 NW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2204
Mailing Address - Country:US
Mailing Address - Phone:305-773-7168
Mailing Address - Fax:
Practice Address - Street 1:7250 NW 77TH ST
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2204
Practice Address - Country:US
Practice Address - Phone:305-773-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN206291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics