Provider Demographics
NPI:1073789293
Name:MICHAEL SANCHEZ DDS
Entity Type:Organization
Organization Name:MICHAEL SANCHEZ DDS
Other - Org Name:RENAISSANCE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-272-0707
Mailing Address - Street 1:12150 E 96TH ST N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5338
Mailing Address - Country:US
Mailing Address - Phone:918-272-0707
Mailing Address - Fax:918-272-0709
Practice Address - Street 1:12150 E 96TH ST N
Practice Address - Street 2:SUITE 106
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5338
Practice Address - Country:US
Practice Address - Phone:918-272-0707
Practice Address - Fax:918-272-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1952396137OtherTYPE 1 NPI