Provider Demographics
NPI:1699005736
Name:SAFARI DENTAL INC
Entity Type:Organization
Organization Name:SAFARI DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-5445
Mailing Address - Street 1:2809 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3121
Mailing Address - Country:US
Mailing Address - Phone:405-737-3441
Mailing Address - Fax:405-737-5445
Practice Address - Street 1:2809 SHADYBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3121
Practice Address - Country:US
Practice Address - Phone:405-737-3441
Practice Address - Fax:405-737-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty