Provider Demographics
NPI:1861892994
Name:MEHDI MOTAKEF D.D.S., M.S. INC.
Entity type:Organization
Organization Name:MEHDI MOTAKEF D.D.S., M.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MARYAM
Authorized Official - Last Name:JAVADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-869-0302
Mailing Address - Street 1:14930 IMPERIAL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2100
Mailing Address - Country:US
Mailing Address - Phone:562-941-4411
Mailing Address - Fax:562-941-0062
Practice Address - Street 1:14930 IMPERIAL HWY STE C
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2100
Practice Address - Country:US
Practice Address - Phone:562-941-4411
Practice Address - Fax:562-941-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223X0400X
CA423721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861892994OtherN/A
CA1861892994Medicaid