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General NPI Number Information
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NPI Number | 1235647850
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Entity Type | Organization
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Legal Business Name | HORMOZDI D.D.S. DENTURE CLINIC, PC
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 5950 N OAK TRFY STE 101
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City | GLADSTONE
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State | MO
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Zip | 64118-5164
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Country | US
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Telephone | 816-298-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 5950 N OAK TRFY STE 101
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City | GLADSTONE
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State | MO
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Zip | 64118-5164
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Country | US
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Telephone | 816-298-0090
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TYRENA L. BELL
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Credential |
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Telephone | 816-298-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2012015475
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License Number State | MO
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