Provider Demographics
NPI:1972799922
Name:ELHAM SAFARI D.D.S., P.C.
Entity type:Organization
Organization Name:ELHAM SAFARI D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-787-7778
Mailing Address - Street 1:555 GROVE ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4705
Mailing Address - Country:US
Mailing Address - Phone:703-787-7778
Mailing Address - Fax:571-203-1390
Practice Address - Street 1:555 GROVE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4705
Practice Address - Country:US
Practice Address - Phone:703-787-7778
Practice Address - Fax:571-203-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty