Provider Demographics
NPI:1205146636
Name:MOHAMED ELSAFI, DDS LLC
Entity type:Organization
Organization Name:MOHAMED ELSAFI, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-362-8574
Mailing Address - Street 1:517 S EUCLID AVE
Mailing Address - Street 2:MCMILLAN BUILDING SUITE 819
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1007
Mailing Address - Country:US
Mailing Address - Phone:314-362-8574
Mailing Address - Fax:
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:MCMILLAN BUILDING SUITE 819
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-8574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100331341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2890Medicare UPIN