Provider Demographics
NPI:1528020542
Name:SAFAR, EGON (DDS MAGD)
Entity Type:Individual
Prefix:
First Name:EGON
Middle Name:
Last Name:SAFAR
Suffix:
Gender:M
Credentials:DDS MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20620 N PARK BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4533
Mailing Address - Country:US
Mailing Address - Phone:216-321-4339
Mailing Address - Fax:
Practice Address - Street 1:20620 N PARK BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4533
Practice Address - Country:US
Practice Address - Phone:216-321-4339
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice