Individual
DR. FARZAD MOTAMEDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
620 W NORTH AVE, MELROSE PARK, IL 60160-1671
(708) 316-2056
Mailing address
107 ASHFORD DR APT 733, WEST MONROE, LA 71291-7853
(615) 428-6572
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7160
LA
1223G0001X
General Practice Dentistry
Primary
019.033940
IL
1223G0001X
General Practice Dentistry
7160
LA
Other
Enumeration date
01/17/2021
Last updated
08/22/2022
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