MEDICARE: DR. JACK SABAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8257	FL

General Provider Information

NPI Number	:	1477604312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK SABAN D.D.S.

Provider Business Mailing Address
First Line	:	150 N UNIVERSITY DR
Second Line	:	SUITE 100
City	:	PLANTATION
State	:	FL
Zip	:	33324-2004
Country	:	US
Telephone Number	:	954-473-4455
Fax Number	:	954-473-0835

Provider Business Practice Location Address
First Line	:	150 N UNIVERSITY DR
Second Line	:	SUITE 100
City	:	PLANTATION
State	:	FL
Zip	:	33324-2004
Country	:	US
Telephone Number	:	954-473-4455
Fax Number	:	954-473-0835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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