Provider Demographics
NPI:1134215080
Name:RAHBAR, ABDOL REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDOL
Middle Name:REZA
Last Name:RAHBAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 HORIZON PARK DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7256
Mailing Address - Country:US
Mailing Address - Phone:770-614-9191
Mailing Address - Fax:770-614-9193
Practice Address - Street 1:2910 HORIZON PARK DR
Practice Address - Street 2:SUITE F
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7256
Practice Address - Country:US
Practice Address - Phone:770-614-9191
Practice Address - Fax:770-614-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice