Provider Demographics
NPI:1144438516
Name:KASSAM, SARAH LALANI (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LALANI
Last Name:KASSAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 WYOMING BLVD NE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3987
Mailing Address - Country:US
Mailing Address - Phone:505-421-1830
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE
Practice Address - Street 2:SUITE B2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3987
Practice Address - Country:US
Practice Address - Phone:505-821-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD28101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice