Healthcare Provider Details

I. General information

NPI: 1891874046
Provider Name (Legal Business Name): SAHAR REZAYAZDI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S JACKSON ST
CUBA CITY WI
53807-1147
US

IV. Provider business mailing address

206 S JACKSON ST
CUBA CITY WI
53807-1147
US

V. Phone/Fax

Practice location:
  • Phone: 608-744-2111
  • Fax: 608-744-2112
Mailing address:
  • Phone: 608-744-2111
  • Fax: 608-744-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1001028-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: