Provider Demographics
NPI:1649402975
Name:SANI, SASAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SASAN
Middle Name:
Last Name:SANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TOSCANA DR
Mailing Address - Street 2:#438
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3482
Mailing Address - Country:US
Mailing Address - Phone:602-380-5310
Mailing Address - Fax:
Practice Address - Street 1:130 SW 91ST AVE APT 302
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2570
Practice Address - Country:US
Practice Address - Phone:602-380-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200311223P0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0300XDental ProvidersDentistPeriodontics