Provider Demographics
NPI:1497275507
Name:CALZADA-SANCHEZ, YOEL
Entity Type:Individual
Prefix:
First Name:YOEL
Middle Name:
Last Name:CALZADA-SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 WALNUT ST APT D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3946
Mailing Address - Country:US
Mailing Address - Phone:281-908-3185
Mailing Address - Fax:
Practice Address - Street 1:10501 ACADEMY RD STE C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1137
Practice Address - Country:US
Practice Address - Phone:215-637-7474
Practice Address - Fax:215-637-4408
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist