Provider Demographics
NPI:1417366964
Name:NIITSU, SANA ABBAS (DDS)
Entity Type:Individual
Prefix:
First Name:SANA ABBAS
Middle Name:
Last Name:NIITSU
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 1:8420 51ST AVE
Mailing Address - Street 2:APARTMENT 2F
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5808
Mailing Address - Country:US
Mailing Address - Phone:317-523-4142
Mailing Address - Fax:
Practice Address - Street 1:8420 51ST AVE
Practice Address - Street 2:APARTMENT 2F
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5808
Practice Address - Country:US
Practice Address - Phone:317-523-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist