MEDICARE: HIRA RANA DMD

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	DN015118	GA
2	1223G0001X	General Practice Dentistry	DN015118	GA

General Provider Information

NPI Number	:	1396103537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIRA RANA DMD

Provider Business Mailing Address
First Line	:	1721 POWDER SPRINGS RD SW
Second Line	:	SUITE 103
City	:	MARIETTA
State	:	GA
Zip	:	30064-4879
Country	:	US
Telephone Number	:	770-293-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 POWDER SPRINGS RD SW
Second Line	:	SUITE 103
City	:	MARIETTA
State	:	GA
Zip	:	30064-4879
Country	:	US
Telephone Number	:	770-293-0605
Fax Number	:

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

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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