Provider Demographics
NPI:1871154203
Name:HECHAVARRIA SANCHEZ, ILVAIN (DMD)
Entity type:Individual
Prefix:
First Name:ILVAIN
Middle Name:
Last Name:HECHAVARRIA SANCHEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S 40TH ST APT 317
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6704
Mailing Address - Country:US
Mailing Address - Phone:215-596-9681
Mailing Address - Fax:
Practice Address - Street 1:301 E CITY AVE STE G5
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1707
Practice Address - Country:US
Practice Address - Phone:610-660-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424011223G0001X
NJ22DI027634001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty