Healthcare Provider Details

I. General information

NPI: 1881104933
Provider Name (Legal Business Name): SAFA NOUREEN SHAMS SAFA MOHD SHAMSHUDDIN D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/06/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 SW 9TH ST
DES MOINES IA
50315-3973
US

IV. Provider business mailing address

935 GARFIELD AVE.
JERSEY CITY NJ
07304-2731
US

V. Phone/Fax

Practice location:
  • Phone: 515-287-0011
  • Fax:
Mailing address:
  • Phone: 201-478-5800
  • Fax: 201-478-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02691500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: