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General NPI Number Information
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NPI Number | 1548683089
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Entity Type | Organization
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Legal Business Name | SIERRA DENTAL INC.
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 4849 SW 148TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-2129
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Country | US
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Telephone | 954-434-1702
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Fax | 954-689-4828
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Provider Business Mailing Address
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Address Line | 4849 SW 148TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-2129
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Country | US
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Telephone | 954-434-1702
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Fax | 954-689-4828
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS L SIERRA
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Credential | DDS
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Telephone | 954-434-1702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0012206
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License Number State | FL
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