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REZA MOVAHED DMD LLC NPI 1740703842


NPI Information

NPI: 1740703842
Provider Name: REZA MOVAHED DMD, LLC

Doing Business As: MID AMERICA ORAL SURGERY AND IMPLANT CENTER

Classification: Clinic/Center - 261QS0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
624 PIERCE BLVD STE 200
O FALLON, IL
ZIP 62269
Phone: (618) 206-2630
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REZA MOVAHED DMD, LLC is an oral and maxillofacial surgery clinic center in O Fallon, IL. The provider is an oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. REZA MOVAHED DMD, LLC NPI is 1740703842. The provider is registered as an organization entity type.
The provider Is Doing Business As Mid America Oral Surgery And Implant Center.

The provider's business location address is:

624 PIERCE BLVD STE 200
O FALLON, IL
ZIP 62269-582
Phone: (618) 206-2630
Fax: (618) 206-2631

The provider's authorized official is Reza Movahed .
The authorized official title is Owner and has the following contact phone number (618) 206-2630.

The enumeration date for this NPI number is 7/20/2017 and was last updated on 1/24/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QS0112XClinic/CenterOral and Maxillofacial SurgeryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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