Provider Demographics
NPI:1356334189
Name:SANCHEZ, PHILLIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:SANCHEZ
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 1:510 NM 528
Mailing Address - Street 2:SUITE I
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004
Mailing Address - Country:US
Mailing Address - Phone:505-867-0665
Mailing Address - Fax:505-867-0180
Practice Address - Street 1:510 NM 528
Practice Address - Street 2:SUITE I
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-867-0665
Practice Address - Fax:505-867-0180
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67711223G0001X
NM31201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice