Provider Demographics
NPI:1912003203
Name:JAMA, SAHARLA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAHARLA
Middle Name:A
Last Name:JAMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MAIL CODE 21113A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:952-883-5151
Mailing Address - Fax:952-883-5160
Practice Address - Street 1:2228 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4321
Practice Address - Country:US
Practice Address - Phone:612-886-3270
Practice Address - Fax:612-677-3330
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN602689300Medicaid