Provider Demographics
NPI:1295830156
Name:SAHAGUN, JUAN DIEGO CERVANTES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN DIEGO
Middle Name:CERVANTES
Last Name:SAHAGUN
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 1:2340 MCKEE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1615
Mailing Address - Country:US
Mailing Address - Phone:408-251-3750
Mailing Address - Fax:408-251-9511
Practice Address - Street 1:2340 MCKEE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1615
Practice Address - Country:US
Practice Address - Phone:408-251-3750
Practice Address - Fax:408-251-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist