Healthcare Provider Details

I. General information

NPI: 1780778712
Provider Name (Legal Business Name): TALA SAFADI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 BRIARFIELD BLVD
MAUMEE OH
43537-9501
US

IV. Provider business mailing address

3210 BRIARFIELD BLVD
MAUMEE OH
43537-9501
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-2400
  • Fax: 419-866-5320
Mailing address:
  • Phone: 419-866-2400
  • Fax: 419-866-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0202267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: