Provider Demographics
NPI:1740901248
Name:UNIQUE DENTAL SPA
Entity type:Organization
Organization Name:UNIQUE DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:470-303-7447
Mailing Address - Street 1:265 WEATHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3445
Mailing Address - Country:US
Mailing Address - Phone:470-303-7447
Mailing Address - Fax:
Practice Address - Street 1:736 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1325
Practice Address - Country:US
Practice Address - Phone:470-303-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty