=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376020149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELCY SANCHEZ D.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2018
-----------------------------------------------------
Last Update Date | 11/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 E. TRINITY MILLS RD SUITE 101
-----------------------------------------------------
City | CARROLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-227-0326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 CROWN KNOLL CIR
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-8501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-918-1769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 33690
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------