Provider Demographics
NPI:1336497403
Name:NIA DENTISTRY LLC
Entity Type:Organization
Organization Name:NIA DENTISTRY LLC
Other - Org Name:NIA PEDIATRIC DENTISTRY AND FAMILY ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTICS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:HAMIDI
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:770-479-9999
Mailing Address - Street 1:150 PROMINENCE POINT PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9108
Mailing Address - Country:US
Mailing Address - Phone:770-479-9999
Mailing Address - Fax:770-479-9990
Practice Address - Street 1:150 PROMINENCE POINT PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9108
Practice Address - Country:US
Practice Address - Phone:770-479-9999
Practice Address - Fax:770-479-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135431223P0221X
GADN0135931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty