Provider Demographics
NPI:1083023113
Name:SABRA, DANIEL ISAAC (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ISAAC
Last Name:SABRA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2542
Mailing Address - Country:US
Mailing Address - Phone:781-596-2220
Mailing Address - Fax:
Practice Address - Street 1:90 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2542
Practice Address - Country:US
Practice Address - Phone:781-596-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN286122300000X
MADN18575361223P0300X
FLDN206321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist