Healthcare Provider Details

I. General information

NPI: 1114835303
Provider Name (Legal Business Name): CHASTAIN DENTAL STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 ROSWELL RD NE STE 4411
ATLANTA GA
30342-3315
US

IV. Provider business mailing address

770 MOCKINGBIRD LN
MARIETTA GA
30068-2356
US

V. Phone/Fax

Practice location:
  • Phone: 770-282-1252
  • Fax: 770-282-1245
Mailing address:
  • Phone: 678-557-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: POOYA HOSEINZADEH
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 770-282-1252