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General NPI Number Information
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NPI Number | 1861892994
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Entity Type | Organization
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Legal Business Name | MEHDI MOTAKEF D.D.S., M.S. INC.
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 14930 IMPERIAL HWY STE C
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City | LA MIRADA
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State | CA
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Zip | 90638-2100
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Country | US
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Telephone | 562-941-4411
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Fax | 562-941-0062
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Provider Business Mailing Address
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Address Line | 14930 IMPERIAL HWY STE C
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City | LA MIRADA
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State | CA
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Zip | 90638-2100
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Country | US
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Telephone | 562-941-4411
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Fax | 562-941-0062
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA MARYAM JAVADPOUR
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Credential |
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Telephone | 310-869-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 42372
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License Number State | CA
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