Provider Demographics
NPI:1639708407
Name:SBO DENTAL PROFESSIONAL CORP
Entity Type:Organization
Organization Name:SBO DENTAL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROSO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-877-3816
Mailing Address - Street 1:1288 VALLEY FORGE RD STE 52
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2687
Mailing Address - Country:US
Mailing Address - Phone:484-920-3687
Mailing Address - Fax:
Practice Address - Street 1:1288 VALLEY FORGE RD STE 52
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2687
Practice Address - Country:US
Practice Address - Phone:484-920-3687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty