Organization
SHAWN DAVAIE MOTLAGH DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN DAVAIE MOTLAGH D.D.S. (PRESIDENT/OWNER)
(949) 307-9144
Entity
Organization
Contact information
Practice address
1333 W OUTER 21 RD, ARNOLD, MO 63010-3239
(636) 333-3304
Mailing address
1333 W OUTER 21 RD, ARNOLD, MO 63010-3239
(636) 333-3304
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2013041566
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992137210
STATE
CA
Enumeration date
01/28/2015
Last updated
01/28/2015
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