Provider Demographics
NPI:1326231135
Name:SIERRA NIEVES, ELSIE JUDITH (DMD)
Entity type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:JUDITH
Last Name:SIERRA NIEVES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 S TAMIAMI TRL FL 2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3842
Mailing Address - Country:US
Mailing Address - Phone:941-366-0474
Mailing Address - Fax:941-366-0292
Practice Address - Street 1:2426 S TAMIAMI TRL FL 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3842
Practice Address - Country:US
Practice Address - Phone:941-366-0474
Practice Address - Fax:941-366-0292
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27941223G0001X
PRDN189671223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice