Healthcare Provider Details

I. General information

NPI: 1174161301
Provider Name (Legal Business Name): JENNA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 EL PASEO RD
LAS CRUCES NM
88001-6045
US

IV. Provider business mailing address

2050 E ALGONQUIN RD STE 610
SCHAUMBURG IL
60173-4166
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-4066
  • Fax: 847-496-4850
Mailing address:
  • Phone: 888-988-4066
  • Fax: 847-496-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: