Provider Demographics
NPI:1336736867
Name:VILLALOBOS SANCHO, SILVIA MARIA
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:MARIA
Last Name:VILLALOBOS SANCHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SILVIA
Other - Middle Name:
Other - Last Name:VILLALOBOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
Mailing Address - Street 1:1000 E 53RD ST UNIT 614
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4380
Mailing Address - Country:US
Mailing Address - Phone:608-628-8911
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-413-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0331521223P0300X
IN12013313A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA