Provider Demographics
NPI:1639247976
Name:ELLIOT SABBAGH DDS PC
Entity Type:Organization
Organization Name:ELLIOT SABBAGH DDS PC
Other - Org Name:FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-327-5001
Mailing Address - Street 1:1927 HOMECREST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2709
Mailing Address - Country:US
Mailing Address - Phone:646-321-5001
Mailing Address - Fax:718-336-1698
Practice Address - Street 1:37 49 82 ST
Practice Address - Street 2:2ND FL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2709
Practice Address - Country:US
Practice Address - Phone:718-779-5178
Practice Address - Fax:718-779-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02210075Medicaid