Provider Demographics
NPI:1386717056
Name:SAFABAKHSH, MASIH (DDS)
Entity type:Individual
Prefix:DR
First Name:MASIH
Middle Name:
Last Name:SAFABAKHSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BLAIRS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5804
Mailing Address - Country:US
Mailing Address - Phone:319-393-7000
Mailing Address - Fax:319-294-5814
Practice Address - Street 1:1515 BLAIRS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5804
Practice Address - Country:US
Practice Address - Phone:319-393-7000
Practice Address - Fax:319-294-5814
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1099960Medicaid