MEDICARE: FATEMEH TAHER

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	012257	GA

General Provider Information

NPI Number	:	1477606143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATEMEH TAHER

Provider Business Mailing Address
First Line	:	3370 SUGARLOAF PKWY
Second Line	:	SUITE G-8
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	678-215-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3370 SUGARLOAF PKWY
Second Line	:	SUITE G-8
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	678-215-1300
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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Directions to “ FATEMEH TAHER ” Practice Location

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