Provider Demographics
NPI:1144887464
Name:SARFRAZ, AMEN (DMD)
Entity type:Individual
Prefix:DR
First Name:AMEN
Middle Name:
Last Name:SARFRAZ
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 1:1770 GATEWAY BLVD APT 750
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-9037
Mailing Address - Country:US
Mailing Address - Phone:408-807-1627
Mailing Address - Fax:
Practice Address - Street 1:3131 MILTON AVE STE 190
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0244
Practice Address - Country:US
Practice Address - Phone:608-322-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032087122300000X
WI1002229-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist