Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN18542 | FL |
NPI | 1104896554 |
---|---|
Provider Name | Allan Sandor |
First Address | Jacksonville, FL 32256-9675 |
Second Address | Jacksonville, FL 32256-9675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 24/07/2013 |