Provider Demographics
NPI:1346816121
Name:PAYANDEH, MEHRAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:
Last Name:PAYANDEH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2802
Mailing Address - Country:US
Mailing Address - Phone:860-913-8808
Mailing Address - Fax:
Practice Address - Street 1:3621 VININGS SLOPE SE STE 4350
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4193
Practice Address - Country:US
Practice Address - Phone:770-444-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1226471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice