MEDICARE: HORMOZ HORMOZDI

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	2012015475	MO

General Provider Information

NPI Number	:	1871853853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HORMOZ HORMOZDI

Provider Business Mailing Address
First Line	:	5950 N OAK TRFY STE 101
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-298-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 N OAK TRFY STE 101
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5164
Country	:	US
Telephone Number	:	816-298-0090
Fax Number	:

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

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	12/21/2015

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Directions to “ HORMOZ HORMOZDI ” Practice Location

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