Provider Demographics
NPI:1417027319
Name:SAFARIAN, SHEILA (DDS)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SAFARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21128 CALISTOGA ROAD
Mailing Address - Street 2:#0123
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461
Mailing Address - Country:US
Mailing Address - Phone:707-987-3307
Mailing Address - Fax:707-987-3318
Practice Address - Street 1:21128 CALISTOGA ROAD
Practice Address - Street 2:#0123
Practice Address - City:MIDDLETOWN
Practice Address - State:CA
Practice Address - Zip Code:95461
Practice Address - Country:US
Practice Address - Phone:707-987-3307
Practice Address - Fax:707-987-3318
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist