Provider Demographics
NPI:1174674014
Name:SIFRI, TAMIM M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMIM
Middle Name:M
Last Name:SIFRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 LINDBERGH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5833
Mailing Address - Country:US
Mailing Address - Phone:608-347-8246
Mailing Address - Fax:
Practice Address - Street 1:107 N CROSBY AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3333
Practice Address - Country:US
Practice Address - Phone:608-752-7931
Practice Address - Fax:608-752-4826
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5941-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice