Provider Demographics
NPI:1649280751
Name:MORESCHINI, SYLVIA R (DDS)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:R
Last Name:MORESCHINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2916
Mailing Address - Country:US
Mailing Address - Phone:505-438-3276
Mailing Address - Fax:505-474-8201
Practice Address - Street 1:4041 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2916
Practice Address - Country:US
Practice Address - Phone:505-438-3276
Practice Address - Fax:505-474-8201
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8701122300000X
NMDD3778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51152380Medicaid