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General NPI Number Information
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NPI Number | 1649818048
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Entity Type | Individual
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Provider Name | SAFA TAHMASEBI
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Gender | Male
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 8375 DIX ELLIS TRL # 110
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8273
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Country | US
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Telephone | 704-323-5390
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Fax |
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Provider Business Mailing Address
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Address Line | 11755 FLOWERING PEACH CT
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6893
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Country | US
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Telephone | 980-339-6333
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN25450
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License Number State | FL
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