Provider Demographics
NPI:1396930558
Name:KASHLAN, MUNIR
Entity type:Individual
Prefix:
First Name:MUNIR
Middle Name:
Last Name:KASHLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 UPPER HEMBREE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0914
Mailing Address - Country:US
Mailing Address - Phone:770-346-8989
Mailing Address - Fax:770-346-8995
Practice Address - Street 1:1240 UPPER HEMBREE RD STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0914
Practice Address - Country:US
Practice Address - Phone:770-346-8989
Practice Address - Fax:770-346-8995
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN10852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist