Provider Demographics
NPI:1598112229
Name:SABINO, GREGORY JOHN (DDS, PH D)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:SABINO
Suffix:
Gender:M
Credentials:DDS, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4811
Mailing Address - Country:US
Mailing Address - Phone:847-924-4479
Mailing Address - Fax:
Practice Address - Street 1:651 NAUTICA DR UNIT 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7222
Practice Address - Country:US
Practice Address - Phone:904-423-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice