Provider Demographics
NPI:1831513142
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:305-558-9995
Mailing Address - Street 1:2387 W 68TH ST
Mailing Address - Street 2:SUITE #302
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6889
Mailing Address - Country:US
Mailing Address - Phone:305-558-9995
Mailing Address - Fax:305-055-8995
Practice Address - Street 1:2387 W 68TH ST
Practice Address - Street 2:SUITE # 302
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6889
Practice Address - Country:US
Practice Address - Phone:305-558-9995
Practice Address - Fax:305-558-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00122061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty