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NPI Code Detail

MEDICARE: DR. JOHNNY BOYD SANDIFER D.M.D.

MEDICARE: DR. JOHNNY BOYD SANDIFER D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodonticsDN17316FL

General Provider Information

NPI Number : 1538102785
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHNNY BOYD SANDIFER D.M.D.
Provider Business Mailing Address
First Line : 710 LAKE CATHERINE DR
Second Line :
City : MAITLAND
State : FL
Zip : 32751-5539
Country : US
Telephone Number : 843-270-2106
Fax Number : 843-792-7809
Provider Business Practice Location Address
First Line : 234 N ORANGE BLOSSOM TRL
Second Line :
City : ORLANDO
State : FL
Zip : 32805-1612
Country : US
Telephone Number : 407-428-1672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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