MEDICARE: GIOVANNI A SAFDARI MD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2008019427	MO
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2008019427	MO

General Provider Information

NPI Number	:	1053574517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIOVANNI A SAFDARI MD, DDS

Provider Business Mailing Address
First Line	:	1724 NEBRASKA AVE
Second Line	:	USA DENTAC
City	:	FT LEONARD WOOD
State	:	MO
Zip	:	65473
Country	:	US
Telephone Number	:	573-596-0388
Fax Number	:	573-596-0410

Provider Business Practice Location Address
First Line	:	1724 NEBRASKA AVE
Second Line	:	USA DENTAC
City	:	FT LEONARD WOOD
State	:	MO
Zip	:	65473
Country	:	US
Telephone Number	:	573-596-0388
Fax Number	:	573-596-0410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2008
Last Update Date	:	07/16/2015

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