=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558579599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE MICHELLE SANCHEZ DILS RDH, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 UNIVERSITY OF NEW MEXICO MSC09 5020
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87131-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-0838
-----------------------------------------------------
Fax | 505-272-5584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1512 MESILLA ST NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-7230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-262-9806
-----------------------------------------------------
Fax | 505-272-5584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH1415
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------