Provider Demographics
NPI:1033152251
Name:SABER, IRA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:J
Last Name:SABER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:CONVENT STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:07961
Mailing Address - Country:US
Mailing Address - Phone:973-644-4620
Mailing Address - Fax:973-644-4597
Practice Address - Street 1:110 BERGEN STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101-1709
Practice Address - Country:US
Practice Address - Phone:973-972-4717
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009063001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2811804Medicaid
NJ030825CY8Medicare ID - Type Unspecified
NJ2811804Medicaid