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General NPI Number Information
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NPI Number | 1851369102
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Entity Type | Individual
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Provider Name | RAMIN RAHNEMA-TABATABAI DDS
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Gender | Male
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Dates
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Enumeration Date | 03/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 692 GLYNN ST N SUITE S
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-6714
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Country | US
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Telephone | 770-719-0020
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Fax | 770-719-0042
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Provider Business Mailing Address
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Address Line | 105 WOODSONG DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1179
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Country | US
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Telephone | 678-925-8440
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DNO 12840
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License Number State | GA
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