Healthcare Provider Details

I. General information

NPI: 1447948187
Provider Name (Legal Business Name): YAMEN SAFADI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8056 ROLLING RD
SPRINGFIELD VA
22153-2928
US

IV. Provider business mailing address

4211 RIDGE TOP RD APT 4303
FAIRFAX VA
22030-1112
US

V. Phone/Fax

Practice location:
  • Phone: 571-648-0038
  • Fax:
Mailing address:
  • Phone: 443-447-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberT-000410
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDLT2000006
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401418578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: