Healthcare Provider Details

I. General information

NPI: 1649262437
Provider Name (Legal Business Name): JOSE ANTONIO CINTRON SOSTRE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE A CINTRON D.M.D.

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N. LAFAYETTE DR SUITE C
SUMTER SC
29150-2984
US

IV. Provider business mailing address

1105 N. LAFAYETTE DR SUITE C
SUMTER SC
29150-2984
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-3600
  • Fax: 803-774-4560
Mailing address:
  • Phone: 803-774-3600
  • Fax: 803-774-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401415038
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2416
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9725
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: