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General NPI Number Information
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NPI Number | 1407073877
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Entity Type | Individual
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Provider Name | ALI MEHRABAN D.M.D
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4060 JOHNS CREEK PKWY BUILDING C
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City | SUWANEE
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State | GA
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Zip | 30024-1254
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Country | US
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Telephone | 678-205-3777
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Fax | 678-205-3888
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Provider Business Mailing Address
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Address Line | 1935 VINEYARD CT
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City | ALPHARETTA
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State | GA
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Zip | 30004-7831
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Country | US
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Telephone | 678-770-0064
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Fax | 678-205-3888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 011676
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License Number State | GA
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