Healthcare Provider Details

I. General information

NPI: 1851969745
Provider Name (Legal Business Name): MITCHELL V SABBAGH DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NORWOOD AVE
DEAL NJ
07723-1268
US

IV. Provider business mailing address

110 NORWOOD AVE
DEAL NJ
07723-1268
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-3311
  • Fax:
Mailing address:
  • Phone: 325-313-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL SABBAGH
Title or Position: OWNER
Credential: DMD
Phone: 732-531-3311