Provider Demographics
NPI:1013402320
Name:SANIE, ELIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:SANIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9708 FIVE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1109
Mailing Address - Country:US
Mailing Address - Phone:571-228-2826
Mailing Address - Fax:
Practice Address - Street 1:740 OLD FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-5881
Practice Address - Country:US
Practice Address - Phone:540-489-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL13686122300000X
MADL14124122300000X
VA0401416677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist