Healthcare Provider Details

I. General information

NPI: 1972869998
Provider Name (Legal Business Name): TECH DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FERST DR NW # 207
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

740 FERST DR NW # 207
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-733-2022
  • Fax: 404-393-1154
Mailing address:
  • Phone: 404-733-2022
  • Fax: 404-393-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FARHAD NIA
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 404-733-2022