Provider Demographics
NPI:1235246851
Name:SAFAEI, PARISA (DMD)
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:SAFAEI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 BEACON STREET
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-332-2872
Mailing Address - Fax:
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:617-332-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice