Provider Demographics
NPI:1902329816
Name:SANCHEZ, DIEGO FERNANDO (DMD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:FERNANDO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 NW 183RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2946
Mailing Address - Country:US
Mailing Address - Phone:786-286-7901
Mailing Address - Fax:
Practice Address - Street 1:5218 JAMMES RD STE D
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7740
Practice Address - Country:US
Practice Address - Phone:904-778-0990
Practice Address - Fax:904-373-9126
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist