Provider Demographics
NPI:1649765892
Name:SAM SAFADI DDS MS PLLC
Entity type:Organization
Organization Name:SAM SAFADI DDS MS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-388-3626
Mailing Address - Street 1:121 EDINBURGH SOUTH DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6490
Mailing Address - Country:US
Mailing Address - Phone:919-434-0177
Mailing Address - Fax:919-800-3995
Practice Address - Street 1:121 EDINBURGH SOUTH DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6490
Practice Address - Country:US
Practice Address - Phone:919-434-0177
Practice Address - Fax:919-800-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty