Provider Demographics
NPI:1427809169
Name:HAJIBABAEI, SAHAR
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:HAJIBABAEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 RUM RUNNER WAY
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2279
Mailing Address - Country:US
Mailing Address - Phone:703-862-0529
Mailing Address - Fax:
Practice Address - Street 1:14006 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1597
Practice Address - Country:US
Practice Address - Phone:904-921-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist