Healthcare Provider Details

I. General information

NPI: 1275013054
Provider Name (Legal Business Name): ANDREW D SINCLAIR DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-9241
  • Fax:
Mailing address:
  • Phone: 904-542-9241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN31388
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4001-18
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4001-18
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: