Healthcare Provider Details

I. General information

NPI: 1134187735
Provider Name (Legal Business Name): JENNIFER VICTORIA SABOL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/27/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TINGAY DENTAL CLINIC 320 WEST HOSPITAL ROAD
FORT GORDON GA
30905
US

IV. Provider business mailing address

320 E HOSPTIAL RD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-4106
  • Fax:
Mailing address:
  • Phone: 706-787-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number50049694
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number049694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: