Provider Demographics
NPI:1083618664
Name:IVI Z SANGUINETTI DDS PA
Entity Type:Organization
Organization Name:IVI Z SANGUINETTI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVI
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SANGUINETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:281-421-5950
Mailing Address - Street 1:6920 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9646
Mailing Address - Country:US
Mailing Address - Phone:281-421-5950
Mailing Address - Fax:281-421-7828
Practice Address - Street 1:6920 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9646
Practice Address - Country:US
Practice Address - Phone:281-421-5950
Practice Address - Fax:281-421-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111401501Medicaid