Provider Demographics
NPI:1255691697
Name:SAJAN, MURTAZA MAKBUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MURTAZA
Middle Name:MAKBUL
Last Name:SAJAN
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 1:1918 E LAFAYETTE PL UNIT 2007
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1591
Mailing Address - Country:US
Mailing Address - Phone:414-732-1023
Mailing Address - Fax:
Practice Address - Street 1:1918 E LAFAYETTE PL UNIT 2007
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1591
Practice Address - Country:US
Practice Address - Phone:414-732-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6923-15122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health