Provider Demographics
NPI:1083730063
Name:SOBECK, MICHAEL DARYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DARYL
Last Name:SOBECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 HUGUENOT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3921
Mailing Address - Country:US
Mailing Address - Phone:718-948-2332
Mailing Address - Fax:718-948-2336
Practice Address - Street 1:836 HUGUENOT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3921
Practice Address - Country:US
Practice Address - Phone:718-948-2332
Practice Address - Fax:718-948-2336
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0386331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038633OtherNY STATE LICENSE NUMBER