MEDICARE: DR. AZADEH ESFANDIARINIA DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN014930	GA

General Provider Information

NPI Number	:	1073906467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZADEH ESFANDIARINIA DMD, MS

Provider Business Mailing Address
First Line	:	6309 ROSWELL RD STE 2A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3220
Country	:	US
Telephone Number	:	678-860-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	6309 ROSWELL RD STE 2A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3220
Country	:	US
Telephone Number	:	678-860-5351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	04/28/2026

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