Provider Demographics
NPI:1215387113
Name:SAGADRACA, TOMMY JOHN CASTILLO (DMD)
Entity Type:Individual
Prefix:
First Name:TOMMY JOHN
Middle Name:CASTILLO
Last Name:SAGADRACA
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 1:211 ENGLISH OAK LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3392
Mailing Address - Country:US
Mailing Address - Phone:630-664-9298
Mailing Address - Fax:
Practice Address - Street 1:1564 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1903
Practice Address - Country:US
Practice Address - Phone:779-771-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0307271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice