Provider Demographics
NPI:1669154902
Name:LAKHANI, NAZAM
Entity type:Individual
Prefix:
First Name:NAZAM
Middle Name:
Last Name:LAKHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 MCMINN WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5508
Mailing Address - Country:US
Mailing Address - Phone:770-356-7360
Mailing Address - Fax:
Practice Address - Street 1:1830 SCENIC HWY N STE 220
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2100
Practice Address - Country:US
Practice Address - Phone:770-844-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1232291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice