Provider Demographics
NPI:1942972419
Name:SBAHI, SADEER JALIL
Entity Type:Individual
Prefix:DR
First Name:SADEER
Middle Name:JALIL
Last Name:SBAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CENTRE ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8600
Mailing Address - Country:US
Mailing Address - Phone:832-834-9381
Mailing Address - Fax:
Practice Address - Street 1:293 LIBBEY INDUSTRIAL PKWY STE A-100
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3139
Practice Address - Country:US
Practice Address - Phone:339-499-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist