Provider Demographics
NPI:1255441804
Name:KABANI, SADRU P (DMD MS)
Entity type:Individual
Prefix:DR
First Name:SADRU
Middle Name:P
Last Name:KABANI
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NEWTON ST G-04
Mailing Address - Street 2:BONSTON UNIV OF DENTAL MED, DEPT OF ORAL & MAXILLO PATH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-5005
Mailing Address - Fax:617-638-4697
Practice Address - Street 1:100 E NEWTON ST G-04
Practice Address - Street 2:BONSTON UNIV OF DENTAL MED, DEPT OF ORAL & MAXILLO PATH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-5005
Practice Address - Fax:617-638-4697
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142781223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3068028OtherAETNA
711511OtherTUFTS HEALTH PLAN
8000239OtherUNITED HEALTH
MA0806005Medicaid
25443OtherFALLON COMM HEALTH
AA1699OtherHARVARD PILGRIM
3068028OtherAETNA
MA0806005Medicaid