Provider Demographics
NPI:1801248372
Name:ABDEL-JABBAR, SANA (DMD)
Entity type:Individual
Prefix:
First Name:SANA
Middle Name:
Last Name:ABDEL-JABBAR
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 1:350 CLUB CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3743
Mailing Address - Country:US
Mailing Address - Phone:954-612-5338
Mailing Address - Fax:
Practice Address - Street 1:350 CLUB CIR APT 202
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3743
Practice Address - Country:US
Practice Address - Phone:954-612-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist