Provider Demographics
NPI:1659444073
Name:BINTORY, AFSHAN SYEDA SHAHANA (DMD)
Entity Type:Individual
Prefix:
First Name:AFSHAN
Middle Name:SYEDA SHAHANA
Last Name:BINTORY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 NORCROSS GLEN TRCE
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1811
Mailing Address - Country:US
Mailing Address - Phone:678-735-8168
Mailing Address - Fax:770-729-8262
Practice Address - Street 1:1235 INDIAN TRAIL LILBURN RD
Practice Address - Street 2:SUITE# 300
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5524
Practice Address - Country:US
Practice Address - Phone:678-735-8168
Practice Address - Fax:770-729-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130161223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice