Provider Demographics
NPI:1477785178
Name:TOSTADO, SERGIO (DDS)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:TOSTADO
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:PO BOX 12385
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0385
Mailing Address - Country:US
Mailing Address - Phone:915-449-8589
Mailing Address - Fax:915-239-2212
Practice Address - Street 1:AVENIDA 6 # 258
Practice Address - Street 2:
Practice Address - City:AGUA PRIETA
Practice Address - State:SONORA
Practice Address - Zip Code:84200
Practice Address - Country:MX
Practice Address - Phone:52633-338-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3235526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist