Provider Demographics
NPI:1639242373
Name:MOETI, HASSAN ALI (DMD)
Entity Type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:ALI
Last Name:MOETI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:HASSAN
Other - Middle Name:
Other - Last Name:ABEDL-MOETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 A LILBURN STONE MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-923-5500
Mailing Address - Fax:770-559-9295
Practice Address - Street 1:5500 LILBURN STONE MOUNTAIN ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087
Practice Address - Country:US
Practice Address - Phone:770-923-5500
Practice Address - Fax:770-559-9295
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0214501223G0001X
GADN013813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice