Provider Demographics
NPI:1205069358
Name:MOUNDS VIEW FAMILY DENTAL
Entity type:Organization
Organization Name:MOUNDS VIEW FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-481-6796
Mailing Address - Street 1:2458 COUNTY ROAD I
Mailing Address - Street 2:APT. 201
Mailing Address - City:MOUNDSVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6235
Mailing Address - Country:US
Mailing Address - Phone:347-481-6796
Mailing Address - Fax:
Practice Address - Street 1:5366 EDGEWOOD DR.
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:347-481-6796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty