Provider Demographics
NPI:1053767400
Name:AVA ORTHODONTICS CYPRESS, PLLC
Entity type:Organization
Organization Name:AVA ORTHODONTICS CYPRESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVAHHEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMD, MS
Authorized Official - Phone:832-617-2222
Mailing Address - Street 1:9822 FRY RD.
Mailing Address - Street 2:SUITE #130
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:832-617-2222
Mailing Address - Fax:
Practice Address - Street 1:9822 FRY RD.
Practice Address - Street 2:SUITE #130
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:832-617-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty