Healthcare Provider Details

I. General information

NPI: 1013640887
Provider Name (Legal Business Name): SARAH MYRIAM ALICIA ASSOUS DAHAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 SHERIDAN ST
HOLLYWOOD FL
33021-3513
US

IV. Provider business mailing address

792 NE 193RD TER
MIAMI FL
33179-3983
US

V. Phone/Fax

Practice location:
  • Phone: 954-289-6480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: