Provider Demographics
NPI:1467566257
Name:AGUILAR, SERGIO RICARDO (DDS)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:RICARDO
Last Name:AGUILAR
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 1:520 N MAIN STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4623
Mailing Address - Country:US
Mailing Address - Phone:714-835-4057
Mailing Address - Fax:714-835-4058
Practice Address - Street 1:520 N MAIN STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4623
Practice Address - Country:US
Practice Address - Phone:714-835-4057
Practice Address - Fax:714-835-4058
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36881208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice