Provider Demographics
NPI:1326096587
Name:SABATINE, MATTHEW NICHOLAS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NICHOLAS
Last Name:SABATINE
Suffix:JR
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 1:137 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013
Mailing Address - Country:US
Mailing Address - Phone:610-588-4679
Mailing Address - Fax:610-599-1094
Practice Address - Street 1:137 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013
Practice Address - Country:US
Practice Address - Phone:610-588-4679
Practice Address - Fax:610-599-1094
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016823L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005132200001Medicaid