MEDICARE: HAYTHAM MUSTAFA SAFI D.D.S

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	019.027782	IL

General Provider Information

NPI Number	:	1922243369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYTHAM MUSTAFA SAFI D.D.S

Provider Business Mailing Address
First Line	:	4953 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2505
Country	:	US
Telephone Number	:	773-655-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	4953 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2505
Country	:	US
Telephone Number	:	773-887-3244
Fax Number	:

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

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	10/01/2014

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