Provider Demographics
NPI:1508604166
Name:SAFENDE, OSAMAH (DMD)
Entity type:Individual
Prefix:
First Name:OSAMAH
Middle Name:
Last Name:SAFENDE
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 1:150 E WYNNEWOOD RD APT 22B
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1514
Mailing Address - Country:US
Mailing Address - Phone:818-459-2476
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2608
Practice Address - Country:US
Practice Address - Phone:818-582-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0447631223G0001X
CA1103221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice