Provider Demographics
NPI:1497136329
Name:AVA ORTHODONTICS LEAGUE CITY PLLC
Entity Type:Organization
Organization Name:AVA ORTHODONTICS LEAGUE CITY PLLC
Other - Org Name:AVA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CERTIFIED ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVAHHEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMD, MS
Authorized Official - Phone:832-617-2222
Mailing Address - Street 1:2810 GULF FWY S
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2810 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6825
Practice Address - Country:US
Practice Address - Phone:832-617-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty