Provider Demographics
NPI:1568917334
Name:MOTLAGH, HAMED M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMED
Middle Name:M
Last Name:MOTLAGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 INTEGRA PRESERVE CT
Mailing Address - Street 2:APT. 316
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4517
Mailing Address - Country:US
Mailing Address - Phone:412-443-4216
Mailing Address - Fax:
Practice Address - Street 1:53 14TH ST STE 208
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-232-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist