MEDICARE: DR. AHMED SIRAGE D.M.D.

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	21310	FL

General Provider Information

NPI Number	:	1578945986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED SIRAGE D.M.D.

Provider Business Mailing Address
First Line	:	408 LIBERTY CT
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9107
Country	:	US
Telephone Number	:	954-857-4644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 N FEDERAL HWY
Second Line	:	#105
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3200
Country	:	US
Telephone Number	:	844-343-6853
Fax Number	:

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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