Provider Demographics
NPI:1861002388
Name:NAWAZISH, SAFA (DDS)
Entity Type:Individual
Prefix:
First Name:SAFA
Middle Name:
Last Name:NAWAZISH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ALMEDA RD APT 9107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4341
Mailing Address - Country:US
Mailing Address - Phone:816-330-1580
Mailing Address - Fax:
Practice Address - Street 1:9000 ALMEDA RD APT 9107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4341
Practice Address - Country:US
Practice Address - Phone:816-330-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist