Provider Demographics
NPI:1558159541
Name:SAGASTUME, MARIA GUADALUPE (RDH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:SAGASTUME
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 BROCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2453
Mailing Address - Country:US
Mailing Address - Phone:240-550-6011
Mailing Address - Fax:
Practice Address - Street 1:361 BROCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2453
Practice Address - Country:US
Practice Address - Phone:240-550-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist