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General NPI Number Information
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NPI Number | 1548107253
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Entity Type | Individual
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Provider Name | MOHAMAD EZZAT ABOU EL NASR ORTHODONTIST
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Gender | Male
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 8200 ROBERTS DR STE 100
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-4150
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Country | US
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Telephone | 770-504-4519
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Fax |
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Provider Business Mailing Address
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Address Line | 6919 PEACHTREE DUNWOODY RD APT 418
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City | SANDY SPRINGS
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State | GA
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Zip | 30328
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN122653
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License Number State | GA
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