Provider Demographics
NPI:1619537131
Name:TALATI, KANAN RASHMIKANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KANAN
Middle Name:RASHMIKANT
Last Name:TALATI
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 1:11455 BOXFORD PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7967
Mailing Address - Country:US
Mailing Address - Phone:404-704-2647
Mailing Address - Fax:
Practice Address - Street 1:26 WOOD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1519
Practice Address - Country:US
Practice Address - Phone:312-274-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice