Provider Demographics
NPI:1790276566
Name:ALSAFAR, MOHAMMED (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ALSAFAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 STATE ROAD 13 STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8855
Mailing Address - Country:US
Mailing Address - Phone:904-230-4567
Mailing Address - Fax:
Practice Address - Street 1:1820 STATE ROAD 13 STE 8
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8855
Practice Address - Country:US
Practice Address - Phone:904-230-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857906122300000X
FLDN26406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist