Provider Demographics
NPI:1457466765
Name:KHIEU, ANH T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:T
Last Name:KHIEU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 HIGHWAY 74 N
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1663
Mailing Address - Country:US
Mailing Address - Phone:404-784-1941
Mailing Address - Fax:404-768-1133
Practice Address - Street 1:1522 HIGHWAY 74 N
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1663
Practice Address - Country:US
Practice Address - Phone:404-784-1941
Practice Address - Fax:404-768-1133
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist