Provider Demographics
NPI:1932560034
Name:AHN, JASMINE (DDS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7063 BELLTOLL CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2507
Mailing Address - Country:US
Mailing Address - Phone:213-220-2329
Mailing Address - Fax:
Practice Address - Street 1:7063 BELLTOLL CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2507
Practice Address - Country:US
Practice Address - Phone:213-220-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist