Provider Demographics
NPI:1750895132
Name:SOBOL DENTAL CORPORATION
Entity type:Organization
Organization Name:SOBOL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:833-377-6265
Mailing Address - Street 1:16911 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:#192
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4250
Mailing Address - Country:US
Mailing Address - Phone:833-377-6265
Mailing Address - Fax:
Practice Address - Street 1:23005 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350
Practice Address - Country:US
Practice Address - Phone:833-377-6265
Practice Address - Fax:888-243-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental