Healthcare Provider Details

I. General information

NPI: 1275756744
Provider Name (Legal Business Name): MOHSEN FAGHIHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 WEST BROAD STREET
PATASKALA OH
43062-8118
US

IV. Provider business mailing address

2447 TUCKER TRL
LEWIS CENTER OH
43035
US

V. Phone/Fax

Practice location:
  • Phone: 740-927-5002
  • Fax: 740-927-5004
Mailing address:
  • Phone: 740-927-5002
  • Fax: 740-927-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: