Provider Demographics
NPI:1083480446
Name:NATHAN CHEROF DMD, LLC
Entity Type:Organization
Organization Name:NATHAN CHEROF DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMYAR
Authorized Official - Middle Name:KAMY
Authorized Official - Last Name:DEHDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-421-2830
Mailing Address - Street 1:426 S ATLANTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4903
Mailing Address - Country:US
Mailing Address - Phone:770-248-9215
Mailing Address - Fax:
Practice Address - Street 1:426 S ATLANTA ST STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4903
Practice Address - Country:US
Practice Address - Phone:770-248-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental