Healthcare Provider Details

I. General information

NPI: 1366826265
Provider Name (Legal Business Name): ANA NAWAZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S FRANKLIN ST
JANESVILLE WI
53548-3812
US

IV. Provider business mailing address

113 S FRANKLIN ST
JANESVILLE WI
53548-3812
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-4638
  • Fax: 608-314-9954
Mailing address:
  • Phone: 608-756-4638
  • Fax: 608-314-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2015020287
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number600109815
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: