MEDICARE: AMAR MISTRY DDS

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	1223G0001X	General Practice Dentistry	30.025024	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	DN122972	GA

General Provider Information

NPI Number	:	1104274976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAR MISTRY DDS

Provider Business Mailing Address
First Line	:	6403 COUNTRY RIDGE DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-6549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2472 JETT FERRY RD STE 430
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-3059
Country	:	US
Telephone Number	:	770-396-8061
Fax Number	:

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

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	01/02/2025

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