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General NPI Number Information
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NPI Number | 1053574517
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Entity Type | Individual
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Provider Name | GIOVANNI A SAFDARI MD, DDS
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Gender | Male
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Dates
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Enumeration Date | 07/04/2008
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1724 NEBRASKA AVE USA DENTAC
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City | FT LEONARD WOOD
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State | MO
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Zip | 65473
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Country | US
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Telephone | 573-596-0388
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Fax | 573-596-0410
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Provider Business Mailing Address
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Address Line | 1724 NEBRASKA AVE USA DENTAC
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City | FT LEONARD WOOD
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State | MO
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Zip | 65473
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Country | US
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Telephone | 573-596-0388
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Fax | 573-596-0410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2008019427
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2008019427
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License Number State | MO
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