Provider Demographics
NPI:1205480423
Name:IRANMANESH, ABTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ABTIN
Middle Name:
Last Name:IRANMANESH
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 1:108 SANOMA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1394
Mailing Address - Country:US
Mailing Address - Phone:615-473-0273
Mailing Address - Fax:
Practice Address - Street 1:7564 HIGHWAY 72 W STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9437
Practice Address - Country:US
Practice Address - Phone:256-690-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006698-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice