Healthcare Provider Details

I. General information

NPI: 1326694803
Provider Name (Legal Business Name): SARA ABDEL MONEM ALBASTONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

1600 BAITY HILL DR APT 114
CHAPEL HILL NC
27514-3956
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3737
  • Fax:
Mailing address:
  • Phone: 919-444-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number51264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: