Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D009740 | AZ |
NPI | 1003337536 |
---|---|
Provider Name | David Jonathon Sabovich |
First Address | Columbia, SC 29206-1011 |
Second Address | Ft Gordon, GA 30905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 01/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003337536 | NPPES (01) |