Provider Demographics
NPI:1093843021
Name:SANCHEZ, BENJAMIN P
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:P
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MOSSROCK STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5131
Mailing Address - Country:US
Mailing Address - Phone:210-308-6520
Mailing Address - Fax:
Practice Address - Street 1:2803 MOSSROCK STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5131
Practice Address - Country:US
Practice Address - Phone:210-308-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX796406OtherCONCORDIA
TX009102701Medicaid
TXD17048OtherBLUE CROSS BLUE SHIELD