1083889372 NPI number — ATOSA SARRAFI,DMD,PC

Table of content: (NPI 1083889372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083889372 NPI number — ATOSA SARRAFI,DMD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATOSA SARRAFI,DMD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083889372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 E CHESTNUT ST
Provider Second Line Business Mailing Address:
UNIT 3405
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-388-4349
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 E RAND RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
MT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-388-4349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARRAFI
Authorized Official First Name:
ATOSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
617-388-4349

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  019026946 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)