MEDICARE: MISS HEATHER LEE SAFRAN RDH

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	124Q00000X	Dental Hygienist	025245	NY

General Provider Information

NPI Number	:	1982866497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HEATHER LEE SAFRAN RDH

Provider Business Mailing Address
First Line	:	15636 101ST ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3202
Country	:	US
Telephone Number	:	718-344-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1663 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6003
Country	:	US
Telephone Number	:	718-768-7870
Fax Number	:

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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