Provider Demographics
NPI:1437012317
Name:SARBAZ, AMITIS
Entity type:Individual
Prefix:
First Name:AMITIS
Middle Name:
Last Name:SARBAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 VALECREST DR
Mailing Address - Street 2:
Mailing Address - City:ETOBICOKE
Mailing Address - State:ON
Mailing Address - Zip Code:M9A 4P5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 VALECREST DR
Practice Address - Street 2:
Practice Address - City:ETOBICOKE
Practice Address - State:ON
Practice Address - Zip Code:M9A 4P5
Practice Address - Country:CA
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014197141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics