Provider Demographics
NPI:1407957061
Name:SANCHEZ, ANGEL DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAVID
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 1:3201 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-2320
Mailing Address - Country:US
Mailing Address - Phone:713-643-2500
Mailing Address - Fax:713-643-2797
Practice Address - Street 1:3201 BROADWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2320
Practice Address - Country:US
Practice Address - Phone:713-643-2500
Practice Address - Fax:713-643-2797
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16936122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60166-01OtherCHIP
TX16936OtherLICENSE NUMBER
TX1111221-02Medicaid