Provider Demographics
NPI:1760480313
Name:DE JESUS SANCHEZ, LUIS ANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANGEL
Last Name:DE JESUS SANCHEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION CONSTANCIA
Mailing Address - Street 2:1807 PASEO LAS COLONIAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2235
Mailing Address - Country:US
Mailing Address - Phone:787-841-0505
Mailing Address - Fax:787-284-0505
Practice Address - Street 1:1807 PASEO LAS COLONIAS
Practice Address - Street 2:URBANIZACION CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2235
Practice Address - Country:US
Practice Address - Phone:787-841-0505
Practice Address - Fax:787-284-0505
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice