Provider Demographics
NPI:1265221949
Name:MOURTADA, SARA DEANNA (DMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DEANNA
Last Name:MOURTADA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 BENSON AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5261
Mailing Address - Country:US
Mailing Address - Phone:256-239-5459
Mailing Address - Fax:
Practice Address - Street 1:2225 BENSON AVE APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5261
Practice Address - Country:US
Practice Address - Phone:256-239-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program