Provider Demographics
NPI:1871754333
Name:SAFE DENTAL GROUP
Entity type:Organization
Organization Name:SAFE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-238-7233
Mailing Address - Street 1:445 WEST WALNUT ST
Mailing Address - Street 2:#133
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081
Mailing Address - Country:US
Mailing Address - Phone:972-238-7233
Mailing Address - Fax:972-238-8993
Practice Address - Street 1:445 WEST WALNUT ST
Practice Address - Street 2:#133
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:972-238-7233
Practice Address - Fax:972-238-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161869601Medicaid