Provider Demographics
NPI:1790060796
Name:A SAFARI DENTAL
Entity Type:Organization
Organization Name:A SAFARI DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:PETTINATO
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD,MS,PA
Authorized Official - Phone:727-834-8585
Mailing Address - Street 1:4427 ROWAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6198
Mailing Address - Country:US
Mailing Address - Phone:727-834-8585
Mailing Address - Fax:727-834-8584
Practice Address - Street 1:4427 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6198
Practice Address - Country:US
Practice Address - Phone:727-834-8585
Practice Address - Fax:727-834-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159051223P0221X
FMDN195341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty