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General NPI Number Information
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NPI Number | 1164377123
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Entity Type | Organization
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Legal Business Name | GEMSTONE DENTAL SPA LLC (DBA LUX DENTISTRY )
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1155 BLUEGRASS CT STE 5
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City | ALPHARETTA
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State | GA
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Zip | 30004-2489
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Country | US
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Telephone | 678-773-7354
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 BLUEGRASS CT STE 5
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City | ALPHARETTA
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State | GA
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Zip | 30004-2489
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Country | US
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Telephone | 678-773-7354
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. NASIM DOROUDGAR
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Credential | DMD
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Telephone | 678-773-7354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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