Provider Demographics
NPI:1699177964
Name:SAGUE, GUSTAVO A (DDS)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
Last Name:SAGUE
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 1:38 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4405
Mailing Address - Country:US
Mailing Address - Phone:305-246-0460
Mailing Address - Fax:305-246-0516
Practice Address - Street 1:38 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4405
Practice Address - Country:US
Practice Address - Phone:305-246-0460
Practice Address - Fax:305-246-0516
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist