Healthcare Provider Details

I. General information

NPI: 1205146636
Provider Name (Legal Business Name): MOHAMED ELSAFI, DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S EUCLID AVE MCMILLAN BUILDING SUITE 819
SAINT LOUIS MO
63110-1007
US

IV. Provider business mailing address

517 S EUCLID AVE MCMILLAN BUILDING SUITE 819
SAINT LOUIS MO
63110-1007
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-8574
  • Fax:
Mailing address:
  • Phone: 314-362-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2010033134
License Number StateMO

VIII. Authorized Official

Name: DR. MOHAMED ELSAFI
Title or Position: OWNER
Credential: DDS
Phone: 314-362-8574