Active NPI
Sara Nofallah, DMD
- Dentist
- Jacksonville, FL
National Provider Identifier
1457799579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN20120
- Practice address
- 3706 Blanding Blvd
Jacksonville, FL 32210-5243 - Phone
- (904) 777-1477
- NPI assigned
- Jun 11, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN20120 | FL | Primary |
Addresses
Primary practice location
3706 Blanding Blvd
Jacksonville, FL 32210-5243
Mailing address
3706 Blanding Blvd
Jacksonville, FL 32210-5243
Phone (904) 777-1477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160323002267 | FL | Order and Referring Only - Oral Surgery | 4789981481 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1457799579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3706 BLANDING BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322105243",
"telephone_number": "904-777-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3706 BLANDING BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322105243",
"telephone_number": "904-777-1477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOFALLAH",
"first_name": "SARA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-11",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN20120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.