Provider Demographics
NPI:1427188226
Name:SAFAVI, MOJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJAN
Middle Name:
Last Name:SAFAVI
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 1:6448 STAR CRK
Mailing Address - Street 2:STE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4897
Mailing Address - Country:US
Mailing Address - Phone:214-995-7716
Mailing Address - Fax:
Practice Address - Street 1:6448 STAR CRK
Practice Address - Street 2:STE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4897
Practice Address - Country:US
Practice Address - Phone:214-995-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice