Provider Demographics
NPI:1871853853
Name:HORMOZDI, HORMOZ
Entity Type:Individual
Prefix:
First Name:HORMOZ
Middle Name:
Last Name:HORMOZDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 N OAK TRFY STE 101
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5164
Mailing Address - Country:US
Mailing Address - Phone:816-298-0090
Mailing Address - Fax:
Practice Address - Street 1:5950 N OAK TRFY STE 101
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5164
Practice Address - Country:US
Practice Address - Phone:816-298-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist