Provider Demographics
NPI:1831623230
Name:SAFDARI-SADALOO, SARA
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:SAFDARI-SADALOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 BIGELOW BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1232
Mailing Address - Country:US
Mailing Address - Phone:850-570-8108
Mailing Address - Fax:
Practice Address - Street 1:3955 BIGELOW BLVD APT 206
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1232
Practice Address - Country:US
Practice Address - Phone:850-570-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0416501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry