Healthcare Provider Details

I. General information

NPI: 1558997148
Provider Name (Legal Business Name): S. SAFARIAN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 BOARDWALK STE 304
SAN MARCOS CA
92078-2659
US

IV. Provider business mailing address

1040 TIERRA DEL REY STE 211
CHULA VISTA CA
91910-7865
US

V. Phone/Fax

Practice location:
  • Phone: 760-798-1768
  • Fax:
Mailing address:
  • Phone: 619-656-6785
  • Fax: 619-656-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHAHIN SAFARIAN
Title or Position: OWNER
Credential: DMD
Phone: 858-349-7996