MEDICARE: COSMETIC AND IMPLANT DENTISTRY OF KANSAS CITY

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1639765803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMETIC AND IMPLANT DENTISTRY OF KANSAS CITY

Provider Business Mailing Address
First Line	:	2101 CHARLOTTE ST STE 330
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2764
Country	:	US
Telephone Number	:	816-897-4288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 CHARLOTTE ST STE 330
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2764
Country	:	US
Telephone Number	:	816-897-4288
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	MAHDOKHT A. FARAHANI
Credential	:
Telephone Number	:	816-838-2651

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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Directions to “COSMETIC AND IMPLANT DENTISTRY OF KANSAS CITY ” Practice Location

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