Provider Demographics
NPI:1841859634
Name:SARMIENTO, DIORGIS MANUEL (DDS)
Entity type:Individual
Prefix:
First Name:DIORGIS
Middle Name:MANUEL
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DIORGIS
Other - Middle Name:MANUEL
Other - Last Name:SAMIENTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR DIOR
Mailing Address - Street 1:2540 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6208
Mailing Address - Country:US
Mailing Address - Phone:585-500-7619
Mailing Address - Fax:
Practice Address - Street 1:1770 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8122
Practice Address - Country:US
Practice Address - Phone:321-253-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL242041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24204OtherEGNA, SIGNA, DELTA DENTAL, BLUE CROSS BLUE SHIELD, MEDLIFE