Provider Demographics
NPI:1639765803
Name:COSMETIC AND IMPLANT DENTISTRY OF KANSAS CITY
Entity Type:Organization
Organization Name:COSMETIC AND IMPLANT DENTISTRY OF KANSAS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHDOKHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-838-2651
Mailing Address - Street 1:2101 CHARLOTTE ST STE 330
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2764
Mailing Address - Country:US
Mailing Address - Phone:816-897-4288
Mailing Address - Fax:
Practice Address - Street 1:2101 CHARLOTTE ST STE 330
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2764
Practice Address - Country:US
Practice Address - Phone:816-897-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty