MEDICARE: HORMOZDI D.D.S. DENTURE CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	2012015475	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1871853853	OTHER	MO	DENTIST

General Provider Information

NPI Number	:	1235647850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORMOZDI D.D.S. DENTURE CLINIC, PC

Provider Business Mailing Address
First Line	:	5950 N OAK TRFY STE 101
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-298-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 N OAK TRFY STE 101
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-298-0090
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TYRENA L. BELL
Credential	:
Telephone Number	:	816-298-0090

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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