Provider Demographics
NPI:1295142370
Name:NASSERI, SANAZ (DMD)
Entity type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:NASSERI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SANAZ
Other - Middle Name:
Other - Last Name:NASSERI GHIAS ABAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8977 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1182
Mailing Address - Country:US
Mailing Address - Phone:321-279-9306
Mailing Address - Fax:
Practice Address - Street 1:3727 N GOLDENROD RD STE 108
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:407-671-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 208091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice