Healthcare Provider Details

I. General information

NPI: 1053511246
Provider Name (Legal Business Name): HONGLI ZHAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 JIMMY CARTER BLVD
NORCROSS GA
30093-1622
US

IV. Provider business mailing address

5220 JIMMY CARTER BLVD
NORCROSS GA
30093-1622
US

V. Phone/Fax

Practice location:
  • Phone: 770-462-2588
  • Fax:
Mailing address:
  • Phone: 770-462-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN013591
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN013591
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: