Provider Demographics
NPI:1669172870
Name:CANTU, SARA KYONG (DMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:KYONG
Last Name:CANTU
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 1:280 DAVID L. GOLDFEIN ST, BLDG 20
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330
Mailing Address - Country:US
Mailing Address - Phone:575-572-8100
Mailing Address - Fax:
Practice Address - Street 1:280 DAVID L. GOLDFEIN ST, BLDG 20
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330
Practice Address - Country:US
Practice Address - Phone:575-572-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO205601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist