Provider Demographics
NPI:1073963880
Name:SIRAGE, TAREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:SIRAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 W PARMER LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2490
Mailing Address - Country:US
Mailing Address - Phone:512-866-3184
Mailing Address - Fax:
Practice Address - Street 1:12160 W PARMER LN STE 110
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2490
Practice Address - Country:US
Practice Address - Phone:512-866-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist