Provider Demographics
NPI:1013180033
Name:SADATI, ABOULGHASEM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABOULGHASEM
Middle Name:
Last Name:SADATI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10140 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6125
Mailing Address - Country:US
Mailing Address - Phone:561-753-8484
Mailing Address - Fax:
Practice Address - Street 1:10140 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6125
Practice Address - Country:US
Practice Address - Phone:561-753-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN001380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist