MEDICARE: DR. MAJID FEHRESTI 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	1223G0001X	General Practice Dentistry	D12034	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	243672800	OTHER	MN	MEDICAL ASSISTANCE NUMBER

General Provider Information

NPI Number	:	1609928563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAJID FEHRESTI DDS

Provider Business Mailing Address
First Line	:	12027 BUSINESS PARK BLVD N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4526
Country	:	US
Telephone Number	:	763-421-7900
Fax Number	:	763-421-7916

Provider Business Practice Location Address
First Line	:	12027 BUSINESS PARK BLVD N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4526
Country	:	US
Telephone Number	:	763-421-7900
Fax Number	:	763-421-7916

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	04/19/2026

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