Active NPI
Morvarid Monfaredzadeh, DDS, MS
- Periodontics
- Sterling Heights, MI
National Provider Identifier
1063148633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2901601565
- Practice address
- 2041 Fifteenth Mile Road
Sterling Heights, MI 48310-4831 - Phone
- (586) 268-0900
- Fax
- (586) 268-3766
- NPI assigned
- Jul 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 019.033755 | IL | |
| Periodontics | 1223P0300X | 2901601565 | MI | Primary |
Addresses
Primary practice location
2041 Fifteenth Mile Road
Sterling Heights, MI 48310-4831
Mailing address
650 Station Blvd Apt 414
Aurora, IL 60504-4449
Phone (331) 529-4158
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033755 | IL | MD | Periodontist |
| 2901601565 | MI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1063148633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 STATION BLVD APT 414",
"city": "AURORA",
"state": "IL",
"postal_code": "605044449",
"telephone_number": "331-529-4158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2041 FIFTEENTH MILE ROAD",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483104831",
"telephone_number": "586-268-0900",
"fax_number": "586-268-3766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONFAREDZADEH",
"first_name": "MORVARID",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-26",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019.033755",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2901601565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.