Healthcare Provider Details

I. General information

NPI: 1699844779
Provider Name (Legal Business Name): MARTIN ANTHONY SORBERO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MONTGOMERY STREET
CANAJOHARIE NY
13317
US

IV. Provider business mailing address

66 MONTGOMERY STREET
CANAJOHARIE NY
13317
US

V. Phone/Fax

Practice location:
  • Phone: 518-673-5410
  • Fax: 518-673-8285
Mailing address:
  • Phone: 518-673-5410
  • Fax: 518-673-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number037373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: