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General NPI Number Information
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NPI Number | 1639669856
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Entity Type | Organization
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Legal Business Name | JESSICA WAGNER SABO DDS INC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 701 HIGHLAND SPRINGS AVE STE 12
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City | BEAUMONT
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State | CA
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Zip | 92223-2551
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Country | US
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Telephone | 951-769-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 701 HIGHLAND SPRINGS AVE STE 12
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City | BEAUMONT
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State | CA
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Zip | 92223-2551
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Country | US
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Telephone | 951-769-1616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA SABO
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Credential | DDS
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Telephone | 951-769-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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