Provider Demographics
NPI:1902191208
Name:ANWAR, SARA (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ANWAR
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 1:1502 KEMPTON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8077
Mailing Address - Country:US
Mailing Address - Phone:815-600-9980
Mailing Address - Fax:630-271-0356
Practice Address - Street 1:1502 KEMPTON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8077
Practice Address - Country:US
Practice Address - Phone:815-600-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190286591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice