Provider Demographics
NPI:1568089597
Name:MOGHUL, SARA YOUSUF (DMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:YOUSUF
Last Name:MOGHUL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5515
Mailing Address - Country:US
Mailing Address - Phone:201-774-0110
Mailing Address - Fax:
Practice Address - Street 1:125 MURRAY HILL RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6299
Practice Address - Country:US
Practice Address - Phone:910-692-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25041122300000X
CA109800122300000X
NC13566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist