Provider Demographics
NPI:1487231858
Name:SANCHEZ, JORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
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 1:664 PALOMAR ST STE 1103
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2611
Mailing Address - Country:US
Mailing Address - Phone:619-429-3948
Mailing Address - Fax:
Practice Address - Street 1:664 PALOMAR ST STE 1103
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2611
Practice Address - Country:US
Practice Address - Phone:619-429-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist