Provider Demographics
NPI:1578645941
Name:SABBAGH, IMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:
Last Name:SABBAGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:770-475-6136
Mailing Address - Fax:770-475-5037
Practice Address - Street 1:366 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8381
Practice Address - Country:US
Practice Address - Phone:770-475-6136
Practice Address - Fax:770-475-5037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice