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General NPI Number Information
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NPI Number | 1649041641
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Entity Type | Individual
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Provider Name | AMIRSABA MOTAMEDI DDS
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Gender | Male
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 4045 TYRONE BLVD N STE 201
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City | ST PETERSBURG
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State | FL
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Zip | 33709-4118
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Country | US
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Telephone | 727-322-4576
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 TYRONE BLVD N STE 201
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City | ST PETERSBURG
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State | FL
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Zip | 33709-4118
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Country | US
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Telephone | 856-495-5066
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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 | DN31216
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02986900
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License Number State | NJ
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