Provider Demographics
NPI:1164518171
Name:SACKS, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:SACKS
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 1:257 MONMOUTH RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1500
Mailing Address - Country:US
Mailing Address - Phone:732-531-0777
Mailing Address - Fax:732-531-8023
Practice Address - Street 1:257 MONMOUTH RD
Practice Address - Street 2:BUILDING B
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1500
Practice Address - Country:US
Practice Address - Phone:732-531-0777
Practice Address - Fax:732-531-8023
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009067001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice