Provider Demographics
NPI:1386087161
Name:IN NOVA DENTAL MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:IN NOVA DENTAL MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MPHG
Authorized Official - Phone:787-617-7573
Mailing Address - Street 1:CAMINO DE LOS ABADES, MANSION DEL NORTE
Mailing Address - Street 2:NC 28
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00000-0949
Mailing Address - Country:US
Mailing Address - Phone:787-617-7573
Mailing Address - Fax:787-876-2422
Practice Address - Street 1:15 STREET
Practice Address - Street 2:I-4
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-617-7573
Practice Address - Fax:787-876-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty