Provider Demographics
NPI:1942515069
Name:FARAHANI, MAHDOKHT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHDOKHT
Middle Name:A
Last Name:FARAHANI
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 1:825 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-474-4920
Mailing Address - Fax:816-889-1845
Practice Address - Street 1:825 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2323
Practice Address - Country:US
Practice Address - Phone:816-474-4920
Practice Address - Fax:816-889-1845
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25290122300000X
KS60698122300000X
MO20090131921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200734870AMedicaid
KS60698OtherKANSAS DENTAL BOARD
MO2009013192OtherMISSOURI DENTAL BOARD
MOC16000024OtherMEDICARE PTAN
TXG0172817OtherDPS
TXG0172817OtherDPS