Provider Demographics
NPI:1083868749
Name:PARISA SAFAEI D.M.D.
Entity Type:Organization
Organization Name:PARISA SAFAEI D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-599-4505
Mailing Address - Street 1:62 BURRILL STREET
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907
Mailing Address - Country:US
Mailing Address - Phone:781-599-4505
Mailing Address - Fax:781-599-4945
Practice Address - Street 1:62 BURRILL STREET
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:781-599-4505
Practice Address - Fax:781-599-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110641223E0200X
MA201771223G0001X
MA218351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11964OtherBLUE CROSS BLUE SHIELD
MA0218995OtherMASS HEALTH