Provider Demographics
NPI:1982869129
Name:PB DENTAL
Entity Type:Organization
Organization Name:PB DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-289-1871
Mailing Address - Street 1:272 S COLLINS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4625
Mailing Address - Country:US
Mailing Address - Phone:972-289-1871
Mailing Address - Fax:972-329-2530
Practice Address - Street 1:272 S COLLINS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4625
Practice Address - Country:US
Practice Address - Phone:972-289-1871
Practice Address - Fax:972-329-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty