Provider Demographics
NPI:1467693283
Name:MAIWAND, SAFA HORMAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAFA
Middle Name:HORMAT
Last Name:MAIWAND
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 1:2043 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6015
Mailing Address - Country:US
Mailing Address - Phone:702-521-6161
Mailing Address - Fax:
Practice Address - Street 1:2043 STERLING AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6015
Practice Address - Country:US
Practice Address - Phone:702-521-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMDD4992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program