Healthcare Provider Details

I. General information

NPI: 1962412114
Provider Name (Legal Business Name): LUCERO SANABRIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1197
US

V. Phone/Fax

Practice location:
  • Phone: 352-548-6000
  • Fax: 573-596-0410
Mailing address:
  • Phone: 352-548-6000
  • Fax: 573-596-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number052865
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number052865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: