Provider Demographics
NPI:1639542079
Name:MOVASSAGHI, SONYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:
Last Name:MOVASSAGHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34194 AURORA RD
Mailing Address - Street 2:#166
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34194 AURORA RD
Practice Address - Street 2:#166
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139
Practice Address - Country:US
Practice Address - Phone:817-706-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100170122300000X
OH30.24748122300000X
WV41911223G0001X
PADS0406621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist