Provider Demographics
NPI:1295343754
Name:JOSE M SANCHEZ DENTAL CORPORATION
Entity type:Organization
Organization Name:JOSE M SANCHEZ DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-622-8818
Mailing Address - Street 1:117 W WILLOW ST STE A
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1829
Mailing Address - Country:US
Mailing Address - Phone:909-622-8818
Mailing Address - Fax:909-622-8184
Practice Address - Street 1:117 W WILLOW ST STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1829
Practice Address - Country:US
Practice Address - Phone:909-622-8818
Practice Address - Fax:909-622-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487857413Medicaid