Healthcare Provider Details

I. General information

NPI: 1730105180
Provider Name (Legal Business Name): MARYANN C SABINO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELAWARE ST SE 7-174 MOOS TOWER
MINNEAPOLIS MN
55455-0357
US

IV. Provider business mailing address

2854 HIGHWAY 55 SUITE 130
EAGAN MN
55121-2156
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-4435
  • Fax: 612-624-2669
Mailing address:
  • Phone: 651-224-4930
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD11403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: