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General NPI Number Information
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NPI Number | 1407269020
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Entity Type | Individual
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Provider Name | SARA MANSOUR
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Gender | Female
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 644 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-3901
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Country | US
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Telephone | 617-286-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 508B SHERMAN ST APT 27
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City | CANTON
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State | MA
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Zip | 02021-2552
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Country | US
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Telephone |
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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 | DN1856574
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License Number State | MA
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