=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194186551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOLAFAH TRABZOUNI DDS, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2016
-----------------------------------------------------
Last Update Date | 03/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 JOHN WESLEY GILBERT DR GC 1012
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30912-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-721-2371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 ALEXANDER DR #2233
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-0243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-468-9220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DNF 000382
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------