Provider Demographics
NPI:1811044589
Name:SAFARI, MATT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:SAFARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WHITE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1160
Mailing Address - Country:US
Mailing Address - Phone:732-842-1155
Mailing Address - Fax:732-842-0943
Practice Address - Street 1:200 WHITE RD STE 113
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1160
Practice Address - Country:US
Practice Address - Phone:732-842-1155
Practice Address - Fax:732-842-0943
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI212101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8618208Medicaid