MEDICARE: SARA M. EZZAT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI03047600	NJ

General Provider Information

NPI Number	:	1275357741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA M. EZZAT DMD

Provider Business Mailing Address
First Line	:	1861 ROUTE 130
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3026
Country	:	US
Telephone Number	:	732-690-1352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1861 ROUTE 130
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3026
Country	:	US
Telephone Number	:	732-508-0234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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