Provider Demographics
NPI:1104022235
Name:SARRAFI, ATOSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ATOSA
Middle Name:
Last Name:SARRAFI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CHESTNUT ST
Mailing Address - Street 2:UNIT 3405
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2401
Mailing Address - Country:US
Mailing Address - Phone:617-388-4349
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-922-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190269461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice