Provider Demographics
NPI:1649262437
Name:CINTRON SOSTRE, JOSE ANTONIO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:CINTRON SOSTRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:CINTRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1105 N. LAFAYETTE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2984
Mailing Address - Country:US
Mailing Address - Phone:803-774-3600
Mailing Address - Fax:803-774-4560
Practice Address - Street 1:1105 N. LAFAYETTE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2984
Practice Address - Country:US
Practice Address - Phone:803-774-3600
Practice Address - Fax:803-774-4560
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014150381223D0001X
PR24161223G0001X
SC97251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX9725Medicaid