Provider Demographics
NPI:1780266452
Name:SAFIZADEH, DARA (DMD)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:SAFIZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHANNING ST APT B
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4703
Mailing Address - Country:US
Mailing Address - Phone:413-835-1653
Mailing Address - Fax:
Practice Address - Street 1:1400 CENTRE ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2579
Practice Address - Country:US
Practice Address - Phone:857-226-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18592661223G0001X
CT13109390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice