Provider Demographics
NPI:1811076839
Name:SUSAN M BURNS-SANCHEZ
Entity type:Organization
Organization Name:SUSAN M BURNS-SANCHEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTEST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNS-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-896-4657
Mailing Address - Street 1:1117 RIO RANCHO DR SE
Mailing Address - Street 2:STE 19
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1859
Mailing Address - Country:US
Mailing Address - Phone:505-896-4657
Mailing Address - Fax:505-994-1720
Practice Address - Street 1:1117 RIO RANCHO DR SE
Practice Address - Street 2:STE 19
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1859
Practice Address - Country:US
Practice Address - Phone:505-896-4657
Practice Address - Fax:505-994-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty