Provider Demographics
NPI:1568089597
Name:MOGHUL, SARA YOUSUF (DMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:YOUSUF
Last Name:MOGHUL
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 1:1600 SW 78TH AVE APT 1022
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3399
Mailing Address - Country:US
Mailing Address - Phone:201-774-0110
Mailing Address - Fax:
Practice Address - Street 1:5065 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8130
Practice Address - Country:US
Practice Address - Phone:561-501-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist