Healthcare Provider Details

I. General information

NPI: 1770328536
Provider Name (Legal Business Name): RABAB ZAHIDI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 BRANDYWINE RD STE 200
ATLANTA GA
30341-5549
US

IV. Provider business mailing address

1042 ALYSSUM DR NW
ACWORTH GA
30102-8124
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-1000
  • Fax:
Mailing address:
  • Phone: 949-294-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: