Provider Demographics
NPI:1912342122
Name:HEALTHY SMILES OF EAST COBB
Entity Type:Organization
Organization Name:HEALTHY SMILES OF EAST COBB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:HUSAN
Authorized Official - Last Name:ALBZREH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-973-9765
Mailing Address - Street 1:1505 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9110
Mailing Address - Country:US
Mailing Address - Phone:770-973-9765
Mailing Address - Fax:
Practice Address - Street 1:1505 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9110
Practice Address - Country:US
Practice Address - Phone:770-973-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty