Healthcare Provider Details

I. General information

NPI: 1639330178
Provider Name (Legal Business Name): SALLY AKRAWE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11943 EL CAMINO REAL STE 200
SAN DIEGO CA
92130-2597
US

IV. Provider business mailing address

4200 BROOKE CT UNIT 704
SAN DIEGO CA
92122-5289
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-8478
  • Fax:
Mailing address:
  • Phone: 248-346-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: