Healthcare Provider Details

I. General information

NPI: 1306777966
Provider Name (Legal Business Name): JUAN LUIS SANCHEZ DA14992
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 SPRING ST
CAMBRIDGE MA
02141-1815
US

IV. Provider business mailing address

99 SPRING ST
CAMBRIDGE MA
02141-1815
US

V. Phone/Fax

Practice location:
  • Phone: 617-803-3831
  • Fax:
Mailing address:
  • Phone: 617-803-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDA14992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: