Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | S13 | MN |
NPI | 1083639504 |
---|---|
Provider Name | Mr. Andres Roberto Sanchez |
First Address | Eden Prairie, MN 55344-7328 |
Second Address | Eden Prairie, MN 55344-7341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 18/03/2014 |