Healthcare Provider Details

I. General information

NPI: 1255691697
Provider Name (Legal Business Name): MURTAZA MAKBUL SAJAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 E LAFAYETTE PL UNIT 2007
MILWAUKEE WI
53202-1591
US

IV. Provider business mailing address

1918 E LAFAYETTE PL UNIT 2007
MILWAUKEE WI
53202-1591
US

V. Phone/Fax

Practice location:
  • Phone: 414-732-1023
  • Fax:
Mailing address:
  • Phone: 414-732-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6923-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6923-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: