Provider Demographics
NPI:1770968448
Name:MEHANNA, SALLY GABBOUR (DMD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:GABBOUR
Last Name:MEHANNA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 W SKINNER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2769
Mailing Address - Country:US
Mailing Address - Phone:609-373-7418
Mailing Address - Fax:
Practice Address - Street 1:2329 W SKINNER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2769
Practice Address - Country:US
Practice Address - Phone:609-373-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02611100122300000X
AZD009852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist