Provider Demographics
NPI:1780373712
Name:FELFELI, MANIJEH (DMD)
Entity type:Individual
Prefix:DR
First Name:MANIJEH
Middle Name:
Last Name:FELFELI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8832 NW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-2901
Mailing Address - Country:US
Mailing Address - Phone:816-456-9644
Mailing Address - Fax:
Practice Address - Street 1:141 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3670
Practice Address - Country:US
Practice Address - Phone:573-603-1460
Practice Address - Fax:573-603-1462
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023027066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist