Provider Demographics
NPI:1841587367
Name:MOVAHHEDIAN, AMIN (DDS, DMD, MS)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:
Last Name:MOVAHHEDIAN
Suffix:
Gender:M
Credentials:DDS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20920 KUYKENDAHL RD STE F
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3378
Mailing Address - Country:US
Mailing Address - Phone:832-617-2222
Mailing Address - Fax:832-698-1780
Practice Address - Street 1:20920 KUYKENDAHL RD
Practice Address - Street 2:SUITE F
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3378
Practice Address - Country:US
Practice Address - Phone:832-617-2222
Practice Address - Fax:832-698-1780
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2021-04-14
Deactivation Date:2021-03-23
Deactivation Code:
Reactivation Date:2021-04-14
Provider Licenses
StateLicense IDTaxonomies
TX264461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics