Provider Demographics
NPI:1578945986
Name:SIRAGE, AHMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
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 1:408 LIBERTY CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9107
Mailing Address - Country:US
Mailing Address - Phone:954-857-4644
Mailing Address - Fax:
Practice Address - Street 1:1650 N FEDERAL HWY
Practice Address - Street 2:#105
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3200
Practice Address - Country:US
Practice Address - Phone:844-343-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist