Provider Demographics
NPI:1790031953
Name:PARADISO, SARA KAMALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:KAMALI
Last Name:PARADISO
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 1:1414 E 39TH ST
Mailing Address - Street 2:APT 329
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3343
Mailing Address - Country:US
Mailing Address - Phone:469-855-6615
Mailing Address - Fax:
Practice Address - Street 1:600 E BETHANY DR STE 130
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4221
Practice Address - Country:US
Practice Address - Phone:972-396-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist