Provider Demographics
NPI:1659677805
Name:ABOUASSAF, SALLY (DDS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ABOUASSAF
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 1:11005 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7441
Mailing Address - Country:US
Mailing Address - Phone:303-805-3588
Mailing Address - Fax:303-805-0743
Practice Address - Street 1:11005 S PARKER RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7441
Practice Address - Country:US
Practice Address - Phone:303-805-3588
Practice Address - Fax:303-805-0743
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice