Provider Demographics
NPI:1568564540
Name:CHAUHAN, MUHAMMAD HASAN (DMD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:HASAN
Last Name:CHAUHAN
Suffix:
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 1:614 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4969
Mailing Address - Country:US
Mailing Address - Phone:770-456-7100
Mailing Address - Fax:770-456-7103
Practice Address - Street 1:614 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4969
Practice Address - Country:US
Practice Address - Phone:770-456-7100
Practice Address - Fax:770-456-7103
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA296279991FMedicaid