Provider Demographics
NPI:1558386425
Name:DRS. OSOFSKY D.D.S. & SABATELLE, JR. D.M.D
Entity Type:Organization
Organization Name:DRS. OSOFSKY D.D.S. & SABATELLE, JR. D.M.D
Other - Org Name:DR.'S KMON, DDS, OSOFSKY, DDS & SABATELLE, DMD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SABATELLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-448-1830
Mailing Address - Street 1:1 COURT STREET
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-448-1830
Mailing Address - Fax:603-448-1826
Practice Address - Street 1:1 COURT STREET
Practice Address - Street 2:SUITE 270
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-1830
Practice Address - Fax:603-448-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NH25561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH=========OtherFED ID