Provider Demographics
NPI:1043812076
Name:SARRA, STEFANIE DAWOOD HANNA (DMD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:DAWOOD HANNA
Last Name:SARRA
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 1:13311 MANDY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7217
Mailing Address - Country:US
Mailing Address - Phone:619-212-3291
Mailing Address - Fax:
Practice Address - Street 1:7506 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2654
Practice Address - Country:US
Practice Address - Phone:361-489-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice