Provider Demographics
NPI:1831775816
Name:SERGIO JACAS DMD LLC
Entity type:Organization
Organization Name:SERGIO JACAS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JACAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-742-3550
Mailing Address - Street 1:7000 W OAKLAND PARK BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1016
Mailing Address - Country:US
Mailing Address - Phone:954-742-3550
Mailing Address - Fax:
Practice Address - Street 1:7000 W OAKLAND PARK BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1016
Practice Address - Country:US
Practice Address - Phone:954-742-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty