Provider Demographics
NPI:1316604747
Name:GHATTAS, SANDRA NAGY (DMD, MS, MBS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:NAGY
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:DMD, MS, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SE 1ST ST APT 803
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6169 S JOG RD UNIT A8-A9
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6579
Practice Address - Country:US
Practice Address - Phone:954-900-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN263161223E0200X
FL26316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist