Provider Demographics
NPI:1285023911
Name:FARZANEH-JOSEPH, MONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:FARZANEH-JOSEPH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 N MAY AVE STE 424
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6010
Mailing Address - Country:US
Mailing Address - Phone:405-445-0023
Mailing Address - Fax:
Practice Address - Street 1:3919 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-2005
Practice Address - Country:US
Practice Address - Phone:405-787-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK020580260AMedicaid
OK20-0580260-AMedicaid