Provider Demographics
NPI:1700185444
Name:SAFARI AND TRYON GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:SAFARI AND TRYON GENERAL PARTNERSHIP
Other - Org Name:ATLANTIC PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-842-1155
Mailing Address - Street 1:200 WHITE RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1150
Mailing Address - Country:US
Mailing Address - Phone:732-842-1155
Mailing Address - Fax:732-842-0943
Practice Address - Street 1:200 WHITE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1150
Practice Address - Country:US
Practice Address - Phone:732-842-1155
Practice Address - Fax:732-842-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021210001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty