MEDICARE: LITHIA SPRINGS COSMETIC AND FAMILY DENTISTRY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174215727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITHIA SPRINGS COSMETIC AND FAMILY DENTISTRY P.C.

Provider Business Mailing Address
First Line	:	351 THORNTON RD STE 101
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1589
Country	:	US
Telephone Number	:	770-944-9755
Fax Number	:	770-944-1261

Provider Business Practice Location Address
First Line	:	351 THORNTON RD STE 101
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1589
Country	:	US
Telephone Number	:	770-944-9755
Fax Number	:	770-944-1261

Authorized Official
Title or Position	:	OWNER/ DENTIST
Name	:	DR. NAHID BAHRAMI
Credential	:	DMD
Telephone Number	:	770-944-9755

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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