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General NPI Number Information
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NPI Number | 1568917334
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Entity Type | Individual
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Provider Name | HAMED M MOTLAGH D.D.S
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Gender | Male
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 53 14TH ST STE 208
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City | WHEELING
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State | WV
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Zip | 26003
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Country | US
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Telephone | 304-232-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 9100 INTEGRA PRESERVE CT APT. 316
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City | OOLTEWAH
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State | TN
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Zip | 37363-4517
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Country | US
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Telephone | 412-443-4216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4240
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License Number State | WV
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