Provider Demographics
NPI:1861763708
Name:WINDERBAUM, SASHA A (DDS)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:A
Last Name:WINDERBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 NW 18TH AVE
Mailing Address - Street 2:102
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7447
Mailing Address - Country:US
Mailing Address - Phone:786-423-4811
Mailing Address - Fax:
Practice Address - Street 1:1540 NW 18TH AVE
Practice Address - Street 2:102
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7447
Practice Address - Country:US
Practice Address - Phone:786-423-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist