Provider Demographics
NPI:1083816045
Name:SAGAWA, JUAN CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:SAGAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 5TH AVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-352-9391
Mailing Address - Fax:360-753-6164
Practice Address - Street 1:911 5TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-352-9391
Practice Address - Fax:360-753-6164
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist