MEDICARE: DR. SANAZ AMIRAN D.D.S.

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	019028114	IL

General Provider Information

NPI Number	:	1134351083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANAZ AMIRAN D.D.S.

Provider Business Mailing Address
First Line	:	3469 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	630-336-7057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3469 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	630-336-7057
Fax Number	:

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

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/11/2009

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