Provider Demographics
NPI:1659571594
Name:ABUROB, SANA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANA
Middle Name:M
Last Name:ABUROB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SANA
Other - Middle Name:M
Other - Last Name:ABUROB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2900 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7934
Mailing Address - Country:US
Mailing Address - Phone:270-737-6453
Mailing Address - Fax:270-737-0801
Practice Address - Street 1:2900 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7934
Practice Address - Country:US
Practice Address - Phone:270-737-6453
Practice Address - Fax:270-737-0801
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8387122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100051530Medicaid