Healthcare Provider Details

I. General information

NPI: 1598379679
Provider Name (Legal Business Name): DR. MILAN DHANANI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 BEAVER RUIN RD STE 175B
NORCROSS GA
30071-3837
US

IV. Provider business mailing address

2529 GREY MOSS CT
DULUTH GA
30097-6209
US

V. Phone/Fax

Practice location:
  • Phone: 678-722-5212
  • Fax:
Mailing address:
  • Phone: 404-933-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MILAN DHANANI
Title or Position: OWNER
Credential:
Phone: 404-933-1754