| NPI | 1497411953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REZA MOVAHED Owner 314-878-6725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2023-06-02 |