Provider Demographics
NPI:1588328793
Name:SAMPAYO, BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SAMPAYO
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 1:2265 W HILLSBORO BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1114
Mailing Address - Country:US
Mailing Address - Phone:786-486-4088
Mailing Address - Fax:
Practice Address - Street 1:2265 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1114
Practice Address - Country:US
Practice Address - Phone:813-537-8929
Practice Address - Fax:954-427-2436
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN264931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice