Provider Demographics
NPI:1316056120
Name:MICHAEL SABIN DMD PC
Entity type:Organization
Organization Name:MICHAEL SABIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SABIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-947-4066
Mailing Address - Street 1:733 N 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630
Mailing Address - Country:US
Mailing Address - Phone:541-947-4066
Mailing Address - Fax:541-947-3675
Practice Address - Street 1:733 N 1ST STREET
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630
Practice Address - Country:US
Practice Address - Phone:541-947-4066
Practice Address - Fax:541-947-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR58181223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227876Medicaid
OR848004OtherUNITED CONCORDIA