Provider Demographics
NPI:1043997430
Name:DENTISTRY N ORTHODONTICS KENNESAW POINT AT LILBURN
Entity Type:Organization
Organization Name:DENTISTRY N ORTHODONTICS KENNESAW POINT AT LILBURN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYANDUKHTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALANTARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-563-6365
Mailing Address - Street 1:1350 WOOTEN LAKE RD NW STE 203
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1346
Mailing Address - Country:US
Mailing Address - Phone:678-275-2066
Mailing Address - Fax:678-275-2074
Practice Address - Street 1:733 PLEASANT HILL RD NW STE 1202
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2988
Practice Address - Country:US
Practice Address - Phone:678-580-3060
Practice Address - Fax:770-557-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental