MEDICARE: RICARDO M. SANCHEZ, DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	55213	CA

General Provider Information

NPI Number	:	1124385026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO M. SANCHEZ, DDS INC

Provider Business Mailing Address
First Line	:	1415 E COLORADO STREET
Second Line	:	SUITE C
City	:	GLENDALE
State	:	LOS ANGELES
Zip	:	91205
Country	:	UM
Telephone Number	:	818-545-9800
Fax Number	:	818-545-3800

Provider Business Practice Location Address
First Line	:	1415 E COLORADO ST
Second Line	:	SUITE C
City	:	GLENDALE
State	:	CA
Zip	:	91205-1533
Country	:	US
Telephone Number	:	818-545-9800
Fax Number	:	818-545-3800

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KAREN ANN S SOLLER
Credential	:
Telephone Number	:	818-545-9800

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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