1083889372 NPI number — ATOSA SARRAFI,DMD,PC

Table of content: FARHAT S. SIDDIQUI M.D. (NPI 1174886568)

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)