Organization
DENTISTRY AT KENNESAW POINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYANDUKHTA KALANTARI DDS (OWNER)
(678) 275-2066
Entity
Organization
Contact information
Practice address
1350 WOOTEN LAKE RD NW, SUITE 203, KENNESAW, GA 30144-1344
(678) 275-2066
(678) 275-2074
Mailing address
1350 WOOTEN LAKE RD NW, SUITE 203, KENNESAW, GA 30144-1344
(678) 275-2066
(678) 275-2074
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013605
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154041182L
—
GA
Enumeration date
03/22/2016
Last updated
03/22/2016
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