Provider Demographics
NPI:1720238082
Name:THEODORE S. SAFER,DDS,PC
Entity Type:Organization
Organization Name:THEODORE S. SAFER,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-823-0781
Mailing Address - Street 1:45 COHANNET ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3903
Mailing Address - Country:US
Mailing Address - Phone:508-823-0781
Mailing Address - Fax:508-977-0708
Practice Address - Street 1:45 COHANNET ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3903
Practice Address - Country:US
Practice Address - Phone:508-823-0781
Practice Address - Fax:508-977-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15210261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0263427Medicaid