Provider Demographics
NPI:1740770650
Name:JANA SABO DDS INC
Entity Type:Organization
Organization Name:JANA SABO DDS INC
Other - Org Name:OPEN WIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-400-3854
Mailing Address - Street 1:1196 VALENCIA ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3027
Mailing Address - Country:US
Mailing Address - Phone:415-400-3854
Mailing Address - Fax:415-712-7998
Practice Address - Street 1:1196 VALENCIA ST UNIT 106
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3027
Practice Address - Country:US
Practice Address - Phone:415-400-3854
Practice Address - Fax:415-712-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612131223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty