Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2008019427 | MO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2008019427 | MO |
NPI | 1053574517 |
---|---|
Provider Name | Giovanni A Safdari |
First Address | Ft Leonard Wood, MO 65473 |
Second Address | Ft Leonard Wood, MO 65473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2008 |
Last Update Date | 16/07/2015 |