Provider Demographics
NPI:1558450635
Name:AFZALI, MOJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOJAN
Middle Name:
Last Name:AFZALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOJAN
Other - Middle Name:
Other - Last Name:AFZALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:511 SW JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063
Mailing Address - Country:US
Mailing Address - Phone:816-554-7720
Mailing Address - Fax:816-554-9588
Practice Address - Street 1:511 SW JEFFERSON
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063
Practice Address - Country:US
Practice Address - Phone:816-554-7720
Practice Address - Fax:816-554-9588
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist