Provider Demographics
NPI:1407406218
Name:SAS, GEOFFREY LOUIS
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:LOUIS
Last Name:SAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 N ISLAND
Mailing Address - Street 2:
Mailing Address - City:GOLDEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2257
Mailing Address - Country:US
Mailing Address - Phone:786-202-7475
Mailing Address - Fax:
Practice Address - Street 1:1045 KANE CONCOURSE STE 204
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2119
Practice Address - Country:US
Practice Address - Phone:305-916-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN247461223E0200X
NY0604211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics