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General NPI Number Information
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NPI Number | 1902633696
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Entity Type | Organization
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Legal Business Name | IFACE ACADEMY
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 407 BRIDLE PATH
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City | MARIETTA
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State | GA
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Zip | 30068-4911
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Country | US
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Telephone | 954-376-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 407 BRIDLE PATH
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City | MARIETTA
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State | GA
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Zip | 30068-4911
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Country | US
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Telephone | 954-376-2412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHOHREH GHASEMI
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Credential | MD
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Telephone | 954-376-2412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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