Provider Demographics
NPI:1871338806
Name:MOMTAHAN, AFSANEH (DDS)
Entity type:Individual
Prefix:
First Name:AFSANEH
Middle Name:
Last Name:MOMTAHAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:AFSANEH
Other - Middle Name:
Other - Last Name:MOMTAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10501 W 113TH ST APT 5203
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2283
Mailing Address - Country:US
Mailing Address - Phone:913-963-3133
Mailing Address - Fax:
Practice Address - Street 1:8603 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2434
Practice Address - Country:US
Practice Address - Phone:816-436-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62197122300000X
MO20250037721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist