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General NPI Number Information
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NPI Number | 1114835303
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Entity Type | Organization
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Legal Business Name | CHASTAIN DENTAL STUDIO LLC
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 4365 ROSWELL RD NE STE 4411
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City | ATLANTA
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State | GA
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Zip | 30342-3315
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Country | US
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Telephone | 770-282-1252
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Fax | 770-282-1245
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Provider Business Mailing Address
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Address Line | 770 MOCKINGBIRD LN
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City | MARIETTA
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State | GA
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Zip | 30068-2356
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Country | US
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Telephone | 678-557-7176
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | POOYA HOSEINZADEH
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Credential | DMD
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Telephone | 770-282-1252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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