Provider Demographics
NPI:1326235615
Name:AHMADIYAR & MOTAMEDI, IV, PLLC
Entity Type:Organization
Organization Name:AHMADIYAR & MOTAMEDI, IV, PLLC
Other - Org Name:ADVANCED ORAL & FACIAL SURGERY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-898-7645
Mailing Address - Street 1:10406 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1712
Mailing Address - Country:US
Mailing Address - Phone:540-898-7645
Mailing Address - Fax:540-898-7043
Practice Address - Street 1:10406 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1712
Practice Address - Country:US
Practice Address - Phone:540-898-7645
Practice Address - Fax:540-898-7043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHMADIYAR & MOTAMEDI, IV, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty