MEDICARE: DR. MONA FARZANEH-JOSEPH DDS

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	122300000X	Dentist	6587	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285023911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA FARZANEH-JOSEPH DDS

Provider Business Mailing Address
First Line	:	5030 N MAY AVE STE 424
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6010
Country	:	US
Telephone Number	:	405-445-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-2005
Country	:	US
Telephone Number	:	405-787-7827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	06/11/2019

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