Provider Demographics
NPI:1609928563
Name:FEHRESTI, MAJID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAJID
Middle Name:
Last Name:FEHRESTI
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 1:12027 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4526
Mailing Address - Country:US
Mailing Address - Phone:763-421-7900
Mailing Address - Fax:763-421-7916
Practice Address - Street 1:12027 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-4526
Practice Address - Country:US
Practice Address - Phone:763-421-7900
Practice Address - Fax:763-421-7916
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN243672800OtherMEDICAL ASSISTANCE NUMBER