Provider Demographics
NPI:1730873688
Name:SABU, RIYA
Entity type:Individual
Prefix:
First Name:RIYA
Middle Name:
Last Name:SABU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 BRAEBURN CT
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2393
Mailing Address - Country:US
Mailing Address - Phone:651-261-1412
Mailing Address - Fax:
Practice Address - Street 1:4605 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4423
Practice Address - Country:US
Practice Address - Phone:651-261-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist