Provider Demographics
NPI:1154810240
Name:ANTOLIN-SANCHEZ DENTAL GROUP PLLC
Entity type:Organization
Organization Name:ANTOLIN-SANCHEZ DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-237-2353
Mailing Address - Street 1:105 COUNTRY VIEW DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2057
Mailing Address - Country:US
Mailing Address - Phone:682-237-2353
Mailing Address - Fax:682-237-2352
Practice Address - Street 1:105 COUNTRY VIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2057
Practice Address - Country:US
Practice Address - Phone:682-237-2353
Practice Address - Fax:682-237-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396065504OtherNPPES