Provider Demographics
NPI:1053149781
Name:JAMSHIDI, BITA
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:JAMSHIDI
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 1:3805 DALLAS HWY SW STE 806
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1620
Mailing Address - Country:US
Mailing Address - Phone:678-203-3464
Mailing Address - Fax:
Practice Address - Street 1:3805 DALLAS HWY SW STE 806
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1620
Practice Address - Country:US
Practice Address - Phone:678-203-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1235071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice