Provider Demographics
NPI:1225109184
Name:SANSARICQ, PATRICIA (DMD,MPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:SANSARICQ
Suffix:
Gender:F
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KENT RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2722
Mailing Address - Country:US
Mailing Address - Phone:610-476-1186
Mailing Address - Fax:425-650-9570
Practice Address - Street 1:1710 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3352
Practice Address - Country:US
Practice Address - Phone:610-277-8100
Practice Address - Fax:610-277-3347
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0362881223G0001X
NJ22D1023046001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101317208Medicaid
PA101317208Medicaid