Provider Demographics
NPI:1033733324
Name:AL MOUSSALLY, SARAH (DMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:AL MOUSSALLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5837 SEVEN MILE DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-8852
Mailing Address - Country:US
Mailing Address - Phone:352-571-1978
Mailing Address - Fax:
Practice Address - Street 1:5837 SEVEN MILE DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8852
Practice Address - Country:US
Practice Address - Phone:352-571-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24926122300000X
FLDN24926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist