Provider Demographics
NPI:1659543890
Name:VAHID, BANAFSHEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BANAFSHEH
Middle Name:
Last Name:VAHID
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 1:107 ALDERWOOD HL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2548
Mailing Address - Country:US
Mailing Address - Phone:517-902-5719
Mailing Address - Fax:
Practice Address - Street 1:2244 HENDERSON MILL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2760
Practice Address - Country:US
Practice Address - Phone:770-934-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020343122300000X
GADN0145811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist