Provider Demographics
NPI:1508037391
Name:MOTAMEDI, TARAZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARAZ
Middle Name:
Last Name:MOTAMEDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W THIRD ST
Mailing Address - Street 2:STE C
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2364
Mailing Address - Country:US
Mailing Address - Phone:856-234-5040
Mailing Address - Fax:856-234-2445
Practice Address - Street 1:200 W THIRD ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2364
Practice Address - Country:US
Practice Address - Phone:856-234-5040
Practice Address - Fax:856-234-2445
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist