NPIMap

Organization Active NPI

Reza Movahed DMD, LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • O Fallon, IL
National Provider Identifier
1740703842
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
REZA MOVAHED DMD, LLC
Doing business as
Mid America Oral Surgery and Implant Center
Practice address
624 Pierce Blvd Ste 200
O Fallon, IL 62269-2582
Phone
(618) 206-2630
Fax
(618) 206-2631
NPI assigned
Jul 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reza Movahed, DMDNPI 1790923365
Title
Owner
Phone
(618) 206-2630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

624 Pierce Blvd Ste 200
O Fallon, IL 62269-2582

Mailing address

220 Admiral Trost Rd Ste B
Columbia, IL 62236-2163
Phone (618) 344-3456

Other practice location 1

220 Admiral Trost Rd Ste B
Columbia, IL 62236-2163
Phone (618) 344-3456

Other names 1

  • Mid America Oral Surgery and Implant Center Doing business as

National Provider Directory

National Provider Directory

Locations

624 Pierce Blvd
Ste 200
O Fallon, IL 62269
Phone (618) 206-2630

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1740703842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 ADMIRAL TROST RD STE B",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622362163",
            "telephone_number": "618-344-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 PIERCE BLVD STE 200",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692582",
            "telephone_number": "618-206-2630",
            "fax_number": "618-206-2631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Admiral Trost Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "IL",
            "postal_code": "622362163",
            "country_code": "US",
            "telephone_number": "618-344-3456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REZA MOVAHED DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "MOVAHED",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-206-2630",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid America Oral Surgery and Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.