Provider Demographics
NPI:1710352968
Name:SARA BUKHARI, DDS PLLC
Entity Type:Organization
Organization Name:SARA BUKHARI, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-389-4215
Mailing Address - Street 1:7500 E DEER VALLEY RD
Mailing Address - Street 2:UNIT 164
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4814
Mailing Address - Country:US
Mailing Address - Phone:480-389-4215
Mailing Address - Fax:480-383-6199
Practice Address - Street 1:4731 E UNION HILLS DR
Practice Address - Street 2:SUITES 108-110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3310
Practice Address - Country:US
Practice Address - Phone:480-389-4215
Practice Address - Fax:480-383-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD8784261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ721912Medicaid