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General NPI Number Information
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NPI Number | 1003473927
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Entity Type | Individual
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Provider Name | SURA DABBAGH DDS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2019
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Last Update Date | 05/27/2019
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Provider Practice Location Address
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Address Line | 5348 COUNTY ROAD 581
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8612
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Country | US
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Telephone | 813-973-1837
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Fax |
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Provider Business Mailing Address
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Address Line | 1426 HUNTERS RUN DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-6320
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Country | US
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Telephone | 603-892-7938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN24072
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License Number State | FL
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