Provider Demographics
NPI:1790161693
Name:SARDUY, RAYNEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYNEL
Middle Name:
Last Name:SARDUY
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 1:193 LAKEVIEW DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2575
Mailing Address - Country:US
Mailing Address - Phone:305-305-8240
Mailing Address - Fax:
Practice Address - Street 1:193 LAKEVIEW DR APT 202
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2575
Practice Address - Country:US
Practice Address - Phone:305-305-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist