Provider Demographics
NPI:1578827887
Name:SANCHEZ, CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
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:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-0426
Mailing Address - Country:US
Mailing Address - Phone:619-870-9456
Mailing Address - Fax:619-785-3404
Practice Address - Street 1:710 E SAN YSIDRO BLVD
Practice Address - Street 2:SUITE 1007
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3123
Practice Address - Country:US
Practice Address - Phone:619-870-9456
Practice Address - Fax:916-785-3404
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2394636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist