Provider Demographics
NPI:1285981415
Name:CITRUS DENTAL SLEEP MEDICINE, PA
Entity type:Organization
Organization Name:CITRUS DENTAL SLEEP MEDICINE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-726-2849
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-1718
Mailing Address - Country:US
Mailing Address - Phone:352-726-2849
Mailing Address - Fax:352-726-1610
Practice Address - Street 1:2333 FOREST DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3817
Practice Address - Country:US
Practice Address - Phone:352-726-2849
Practice Address - Fax:352-726-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty