Healthcare Provider Details

I. General information

NPI: 1104896554
Provider Name (Legal Business Name): ALLAN SANDOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 BAYMEADOWS RD E STE 4
JACKSONVILLE FL
32256-9675
US

IV. Provider business mailing address

7711 BAYMEADOWS RD E STE 4
JACKSONVILLE FL
32256-9675
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0340
  • Fax:
Mailing address:
  • Phone: 904-240-0340
  • Fax: 904-527-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN18542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: