Provider Demographics
NPI:1255517769
Name:SHAHRIARI, ABTIN (DMD, , MPH)
Entity type:Individual
Prefix:DR
First Name:ABTIN
Middle Name:
Last Name:SHAHRIARI
Suffix:
Gender:M
Credentials:DMD, , MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 ROBIN HOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2658
Mailing Address - Country:US
Mailing Address - Phone:404-444-9616
Mailing Address - Fax:
Practice Address - Street 1:182 ROBIN HOOD RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2658
Practice Address - Country:US
Practice Address - Phone:404-444-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery