Provider Demographics
NPI:1619610888
Name:SAKA DENTAL SPA
Entity Type:Organization
Organization Name:SAKA DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-822-7609
Mailing Address - Street 1:4 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1718
Mailing Address - Country:US
Mailing Address - Phone:732-822-7609
Mailing Address - Fax:
Practice Address - Street 1:614 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-0774
Practice Address - Country:US
Practice Address - Phone:732-822-7609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental