Provider Demographics
NPI:1609070697
Name:TERRY J SOBLER DMD PC
Entity Type:Organization
Organization Name:TERRY J SOBLER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-634-3560
Mailing Address - Street 1:339 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4300
Mailing Address - Country:US
Mailing Address - Phone:845-634-3560
Mailing Address - Fax:845-634-0619
Practice Address - Street 1:339 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4300
Practice Address - Country:US
Practice Address - Phone:845-634-3560
Practice Address - Fax:845-634-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564741Medicaid