Provider Demographics
NPI:1700437118
Name:MOMIN, FARHAN ABBAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARHAN ABBAS
Middle Name:
Last Name:MOMIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2719
Mailing Address - Country:US
Mailing Address - Phone:404-952-3956
Mailing Address - Fax:
Practice Address - Street 1:8709 DALLAS ACWORTH HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2177
Practice Address - Country:US
Practice Address - Phone:770-693-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0159601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice