Provider Demographics
NPI:1356414320
Name:SANCHEZ, GUILLERMO (DDS)
Entity type:Individual
Prefix:
First Name:GUILLERMO
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 1:364 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1921
Mailing Address - Country:US
Mailing Address - Phone:805-524-4448
Mailing Address - Fax:805-524-4893
Practice Address - Street 1:364 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1921
Practice Address - Country:US
Practice Address - Phone:805-524-4448
Practice Address - Fax:805-524-4893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91444-01Medicaid
CA1421049OtherUNITED CONCORDIA
CAB41784-02OtherHEALTHY FAMILIES PROGAM
CAB41784-01OtherHEALTHY FAMILIES PROGRAM
CAG91444-02Medicaid