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General NPI Number Information
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NPI Number | 1740808989
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Entity Type | Individual
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Provider Name | AMIR MOTAMEDI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 1049 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-3731
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Country | US
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Telephone | 909-985-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 53 N EL MOLINO AVE APT 454
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City | PASADENA
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State | CA
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Zip | 91101-5658
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Country | US
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Telephone | 713-517-1205
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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 | 104892
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License Number State | CA
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