Provider Demographics
NPI:1386963635
Name:SAFADI, TAREK HAKAM (DDS)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:HAKAM
Last Name:SAFADI
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 1:209 REGENCY CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8072
Mailing Address - Country:US
Mailing Address - Phone:219-805-8545
Mailing Address - Fax:
Practice Address - Street 1:8159 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8613
Practice Address - Country:US
Practice Address - Phone:219-805-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice