Provider Demographics
NPI:1629143326
Name:SARGI, ELIAS MOUSSA (DDS)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:MOUSSA
Last Name:SARGI
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 1:2700 RIVERSIDE AVENUE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205
Mailing Address - Country:US
Mailing Address - Phone:904-384-0383
Mailing Address - Fax:904-384-0177
Practice Address - Street 1:2700 RIVERSIDE AVENUE
Practice Address - Street 2:STE 10
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205
Practice Address - Country:US
Practice Address - Phone:904-384-0383
Practice Address - Fax:904-384-0177
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice