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General NPI Number Information
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NPI Number | 1144887464
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Entity Type | Individual
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Provider Name | AMEN SARFRAZ DMD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 09/04/2021
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Provider Practice Location Address
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Address Line | 3131 MILTON AVE STE 190
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City | JANESVILLE
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State | WI
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Zip | 53545-0244
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Country | US
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Telephone | 608-322-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 GATEWAY BLVD APT 750
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City | BELOIT
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State | WI
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Zip | 53511-9037
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Country | US
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Telephone | 408-807-1627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019032087
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1002229-15
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License Number State | WI
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