Provider Demographics
NPI:1497106884
Name:MOTEVASEL, HENGAMEH (DDS)
Entity Type:Individual
Prefix:
First Name:HENGAMEH
Middle Name:
Last Name:MOTEVASEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 COTTONWOOD CREEK TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7861
Mailing Address - Country:US
Mailing Address - Phone:512-593-7970
Mailing Address - Fax:
Practice Address - Street 1:5868 E 71ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4075
Practice Address - Country:US
Practice Address - Phone:317-759-1020
Practice Address - Fax:800-269-9947
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362971223X0400X
IN12012494A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist