Provider Demographics
NPI:1568056760
Name:BARAZESH, SARA ELNAZ (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELNAZ
Last Name:BARAZESH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FOREST ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3806
Mailing Address - Country:US
Mailing Address - Phone:908-500-4921
Mailing Address - Fax:
Practice Address - Street 1:132 FOREST ST APT 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3806
Practice Address - Country:US
Practice Address - Phone:908-500-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02872200122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program