Healthcare Provider Details

I. General information

NPI: 1306585930
Provider Name (Legal Business Name): RYAN ERFAN RANJBAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 HIGHWAY 138 NE STE 300
CONYERS GA
30013-1254
US

IV. Provider business mailing address

385 N ANGIER AVE NE UNIT 1436
ATLANTA GA
30308-3105
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-7831
  • Fax:
Mailing address:
  • Phone: 678-684-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122660
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: