Provider Demographics
NPI:1235118969
Name:SAFAR, OSSAMA MURAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:OSSAMA
Middle Name:MURAD
Last Name:SAFAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W ROUTE 66
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4149
Mailing Address - Country:US
Mailing Address - Phone:909-896-0509
Mailing Address - Fax:813-762-1800
Practice Address - Street 1:641 W ROUTE 66
Practice Address - Street 2:SUITE E
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4149
Practice Address - Country:US
Practice Address - Phone:909-896-0509
Practice Address - Fax:813-762-1800
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164361223P0221X
CA553031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075936800Medicaid