Provider Demographics
NPI:1932679008
Name:PARKSIDE DENTAL
Entity Type:Organization
Organization Name:PARKSIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKOOHI DMD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-252-4700
Mailing Address - Street 1:5920 ROSWELL RD STE A201
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4923
Mailing Address - Country:US
Mailing Address - Phone:404-252-4700
Mailing Address - Fax:
Practice Address - Street 1:5920 ROSWELL RD STE A201
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4923
Practice Address - Country:US
Practice Address - Phone:404-252-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental