Provider Demographics
NPI:1275756744
Name:FAGHIHI, MOHSEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:FAGHIHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 TUCKER TRL
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035
Mailing Address - Country:US
Mailing Address - Phone:740-927-5002
Mailing Address - Fax:740-927-5004
Practice Address - Street 1:621 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8118
Practice Address - Country:US
Practice Address - Phone:740-927-5002
Practice Address - Fax:740-927-5004
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist