Healthcare Provider Details

I. General information

NPI: 1841587367
Provider Name (Legal Business Name): AMIN MOVAHHEDIAN DDS, DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date: 03/23/2021
Reactivation Date: 04/14/2021

III. Provider practice location address

20920 KUYKENDAHL RD SUITE F
SPRING TX
77379-3378
US

IV. Provider business mailing address

20920 KUYKENDAHL RD STE F
SPRING TX
77379-3378
US

V. Phone/Fax

Practice location:
  • Phone: 832-617-2222
  • Fax: 832-698-1780
Mailing address:
  • Phone: 832-617-2222
  • Fax: 832-698-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: