Provider Demographics
NPI:1427795327
Name:MOTAMEDI DENTAL CORP
Entity type:Organization
Organization Name:MOTAMEDI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAMEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-330-6655
Mailing Address - Street 1:1031 E AMAR RD
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1340
Mailing Address - Country:US
Mailing Address - Phone:626-330-6655
Mailing Address - Fax:
Practice Address - Street 1:1031 E AMAR RD
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1340
Practice Address - Country:US
Practice Address - Phone:626-330-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental