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General NPI Number Information
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NPI Number | 1649678921
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Entity Type | Organization
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Legal Business Name | SMDENTALPC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 440 FLAT SHOALS AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-1915
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Country | US
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Telephone | 404-688-2223
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Fax | 404-688-6602
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Provider Business Mailing Address
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Address Line | 440 FLAT SHOALS AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-1915
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Country | US
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Telephone | 404-688-2223
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Fax | 404-688-6602
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Authorized Official
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Title or Position | DENTIST/CEO
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Name | DR. SHERVIN MESHKIAN
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Credential | DDS
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Telephone | 404-688-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | DN012987
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License Number State | GA
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