Provider Demographics
NPI:1841356847
Name:SIERRA-DUQUE, PABLO J (DMD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:J
Last Name:SIERRA-DUQUE
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:PO BOX 1900
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1900
Mailing Address - Country:US
Mailing Address - Phone:352-753-7507
Mailing Address - Fax:352-753-5079
Practice Address - Street 1:111 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1302
Practice Address - Country:US
Practice Address - Phone:352-753-7507
Practice Address - Fax:352-753-5079
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17835122300000X
NC7545122300000X
NY051240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist