MEDICARE: DR. SURA DABBAGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN24072	FL

General Provider Information

NPI Number	:	1003473927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURA DABBAGH DDS

Provider Business Mailing Address
First Line	:	1426 HUNTERS RUN DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-6320
Country	:	US
Telephone Number	:	603-892-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5348 COUNTY ROAD 581
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-8612
Country	:	US
Telephone Number	:	813-973-1837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2019
Last Update Date	:	05/27/2019

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