Provider Demographics
NPI:1699844779
Name:SORBERO, MARTIN ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANTHONY
Last Name:SORBERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MONTGOMERY STREET
Mailing Address - Street 2:
Mailing Address - City:CANAJOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:13317
Mailing Address - Country:US
Mailing Address - Phone:518-673-5410
Mailing Address - Fax:518-673-8285
Practice Address - Street 1:66 MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:CANAJOHARIE
Practice Address - State:NY
Practice Address - Zip Code:13317
Practice Address - Country:US
Practice Address - Phone:518-673-5410
Practice Address - Fax:518-673-8285
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0373731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00758356Medicaid