Provider Demographics
NPI:1598319550
Name:SAMIMIFAR, GOLNAZ SADAT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GOLNAZ
Middle Name:SADAT
Last Name:SAMIMIFAR
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 1:201 E MISSISSIPPI AVE APT 539
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4392
Mailing Address - Country:US
Mailing Address - Phone:408-828-3018
Mailing Address - Fax:
Practice Address - Street 1:325 S TELLER ST STE 280
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7389
Practice Address - Country:US
Practice Address - Phone:303-989-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002040451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice