Provider Demographics
NPI:1013068782
Name:HARANDIFASSIH, ALI (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:HARANDIFASSIH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 VIRGINIA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354
Mailing Address - Country:US
Mailing Address - Phone:404-768-8700
Mailing Address - Fax:
Practice Address - Street 1:785 VIRGINIA AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354
Practice Address - Country:US
Practice Address - Phone:404-768-8700
Practice Address - Fax:404-768-8588
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice