Provider Demographics
NPI:1811553308
Name:SIFUENTES CERVANTES, JOSE SALVADOR (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:SALVADOR
Last Name:SIFUENTES CERVANTES
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:DE LA LOMA 105 CUMBRES 2 SECTOR
Mailing Address - Street 2:
Mailing Address - City:MONTERREY
Mailing Address - State:MEXICO
Mailing Address - Zip Code:64610
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 5 AVENIDA CENTRAL JUANITA FINAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-488-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty