Healthcare Provider Details

I. General information

NPI: 1780642132
Provider Name (Legal Business Name): JON GREGORY SABOL DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N. 40TH STREET, #180
PHOENIX AZ
85018
US

IV. Provider business mailing address

5050 N. 40TH STREET, #180
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-0332
  • Fax: 602-957-3282
Mailing address:
  • Phone: 602-957-0332
  • Fax: 602-957-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6816
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: