Provider Demographics
NPI:1013331453
Name:SIERRA DENTAL INC
Entity Type:Organization
Organization Name:SIERRA DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-351-6980
Mailing Address - Street 1:4001 N OCEAN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5968
Mailing Address - Country:US
Mailing Address - Phone:954-351-6980
Mailing Address - Fax:954-351-7927
Practice Address - Street 1:4001 N OCEAN DR
Practice Address - Street 2:SUITE #202
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5968
Practice Address - Country:US
Practice Address - Phone:954-351-6980
Practice Address - Fax:954-351-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty