Provider Demographics
NPI:1720397375
Name:EKHLASSI, SANAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:EKHLASSI
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 1:67 SULLIVAN ST APT D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-5134
Mailing Address - Country:US
Mailing Address - Phone:281-382-6526
Mailing Address - Fax:281-492-9337
Practice Address - Street 1:1744 FRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5801
Practice Address - Country:US
Practice Address - Phone:281-492-8900
Practice Address - Fax:281-492-9337
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257761223G0001X
NY055215-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice