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General NPI Number Information
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NPI Number | 1942432968
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Entity Type | Organization
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Legal Business Name | SABAH DENTAL LLC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 1554 ANNAPOLIS RD
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City | ODENTON
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State | MD
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Zip | 21113-1001
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Country | US
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Telephone | 410-674-7360
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 ANNAPOLIS RD SUITE B
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City | ODENTON
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State | MD
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Zip | 21113-1328
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Country | US
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Telephone | 410-674-7360
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MARIE WILENNE ST. MARTIN
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Credential | DDS
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Telephone | 410-674-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13867
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License Number State | MD
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