MEDICARE: SAFDER OLATHE ENDODONTICS, LLC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1831054204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFDER OLATHE ENDODONTICS, LLC

Provider Business Mailing Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-396-7625
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	MANSOOR SAFDER
Credential	:	DDS, MSD
Telephone Number	:	913-206-2758

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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