Provider Demographics
NPI:1760588164
Name:CERVANTES, SARA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:A
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 OAKFIELD DR
Mailing Address - Street 2:STE B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-681-7882
Mailing Address - Fax:813-643-2102
Practice Address - Street 1:1532 OAKFIELD DR
Practice Address - Street 2:STE B
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-681-7882
Practice Address - Fax:813-643-2102
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1565176OtherUNITED CONCORDIA INS CO