Individual provider Active NPI

Safa Noureen Shams Safa Mohd Shamshuddin, D.M.D

  • Dentist
  • Des Moines, IA
National Provider Identifier
1881104933
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22DI02691500 Issued in NJ
Practice address
4730 SW 9TH St
Des Moines, IA 50315-3973
Phone
(515) 287-0011
NPI assigned
Oct 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22DI02691500 NJ Primary

Addresses

Primary practice location

4730 SW 9TH St
Des Moines, IA 50315-3973

Mailing address

935 Garfield Ave.
Jersey City, NJ 07304-2731
Phone (201) 478-5800

Other practice location 1

Rand Center for dentistry
191 US-206 #11
Flanders, NJ 07836
Phone (973) 370-8917

Other practice location 2

935 garfield Ave.
Jersey City, NJ 07304-2731
Phone (201) 478-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180315000006 NJ Order and Referring Only - DentistPractitioner - Dentist 0547522377

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI02691500NJMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
A Plus Iowa Dental PLLC Dentist PastSince Oct 9, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1881104933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 GARFIELD AVE.",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073042731",
            "telephone_number": "201-478-5800",
            "fax_number": "201-478-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503153973",
            "telephone_number": "515-287-0011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Rand Center for dentistry",
            "address_2": "191 US-206 #11",
            "address_purpose": "LOCATION",
            "city": "Flanders",
            "state": "NJ",
            "postal_code": "07836",
            "country_code": "US",
            "telephone_number": "973-370-8917",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "935 garfield Ave.",
            "address_purpose": "LOCATION",
            "city": "Jersey City",
            "state": "NJ",
            "postal_code": "073042731",
            "country_code": "US",
            "telephone_number": "201-478-5800",
            "fax_number": "201-478-5814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAFA MOHD SHAMSHUDDIN",
        "first_name": "SAFA NOUREEN SHAMS",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-03",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02691500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.