Healthcare Provider Details

I. General information

NPI: 1609010644
Provider Name (Legal Business Name): ROLAND KENT SANCHEZ II D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 CHRISTOPHER DR
BELEN NM
87002-2629
US

IV. Provider business mailing address

704 CHRISTOPHER DR
BELEN NM
87002-2629
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-7000
  • Fax: 505-864-6474
Mailing address:
  • Phone: 505-864-7000
  • Fax: 505-864-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3285
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: