Provider Demographics
NPI:1497749063
Name:SABUDA, THOMAS JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:SABUDA
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 1:38 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELEVAN
Mailing Address - State:NY
Mailing Address - Zip Code:14042-9501
Mailing Address - Country:US
Mailing Address - Phone:716-707-7040
Mailing Address - Fax:
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9501
Practice Address - Country:US
Practice Address - Phone:716-707-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA02884011223G0001X
PADS019205L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00628542Medicaid