Healthcare Provider Details

I. General information

NPI: 1649280751
Provider Name (Legal Business Name): SYLVIA R MORESCHINI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 CERRILLOS RD
SANTA FE NM
87507-2916
US

IV. Provider business mailing address

4041 CERRILLOS RD
SANTA FE NM
87507-2916
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-3276
  • Fax: 505-474-8201
Mailing address:
  • Phone: 505-438-3276
  • Fax: 505-474-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8701
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3778
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: