Provider Demographics
NPI:1952495889
Name:ANILLO-SARMIENTO, JUAN A (DMS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:ANILLO-SARMIENTO
Suffix:
Gender:M
Credentials:DMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 BRAGANZA AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6307
Mailing Address - Country:US
Mailing Address - Phone:305-382-5000
Mailing Address - Fax:305-382-1615
Practice Address - Street 1:10201 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 146
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4712
Practice Address - Country:US
Practice Address - Phone:305-382-5000
Practice Address - Fax:305-382-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice