Healthcare Provider Details

I. General information

NPI: 1023016748
Provider Name (Legal Business Name): MICHAEL ALAN KAHN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N. DECATUR RD.
DECATUR GA
30033-5918
US

IV. Provider business mailing address

2701 N. DECATUR RD.
DECATUR GA
30033-5918
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-7445
  • Fax: 404-501-7460
Mailing address:
  • Phone: 404-501-7445
  • Fax: 404-501-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number20500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: