Healthcare Provider Details

I. General information

NPI: 1518459544
Provider Name (Legal Business Name): SANA NASIR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PKWY STE 103R
COLUMBIA MD
21044-3081
US

IV. Provider business mailing address

9384 COLBERT CT
FAIRFAX VA
22032-2000
US

V. Phone/Fax

Practice location:
  • Phone: 410-992-4400
  • Fax:
Mailing address:
  • Phone: 703-867-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number16924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: