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General NPI Number Information
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NPI Number | 1407361702
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Entity Type | Organization
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Legal Business Name | BUCKHEAD COSMETIC AND FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 316 PHARR RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2304
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Country | US
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Telephone | 404-400-0400
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Fax | 404-393-6929
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Provider Business Mailing Address
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Address Line | 316 PHARR RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2304
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Country | US
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Telephone | 404-400-0400
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Fax | 404-393-6929
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Authorized Official
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Title or Position | OWNER
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Name | BAHAREH EMADZADEH NIA
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Credential | DMD
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Telephone | 404-400-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DN013675
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License Number State | GA
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