MEDICARE: SAFARI DENTAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5183	OK

General Provider Information

NPI Number	:	1699005736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFARI DENTAL INC

Provider Business Mailing Address
First Line	:	2809 SHADYBROOK DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3121
Country	:	US
Telephone Number	:	405-737-3441
Fax Number	:	405-737-5445

Provider Business Practice Location Address
First Line	:	2809 SHADYBROOK DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3121
Country	:	US
Telephone Number	:	405-737-3441
Fax Number	:	405-737-5445

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. NIKITA J MENSER
Credential	:
Telephone Number	:	405-737-5445

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	01/13/2010

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Directions to “SAFARI DENTAL INC ” Practice Location

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