Provider Demographics
NPI:1750950341
Name:NAMDARI, SHOLEH
Entity type:Individual
Prefix:DR
First Name:SHOLEH
Middle Name:
Last Name:NAMDARI
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 1:2250 KINGS WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4494
Mailing Address - Country:US
Mailing Address - Phone:470-747-9440
Mailing Address - Fax:
Practice Address - Street 1:4373 JIMMY LEE SMITH PKWY STE 105
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2642
Practice Address - Country:US
Practice Address - Phone:678-225-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1223151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice