Organization
LAWRENCEVILLE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAYEEM BASHAR DDS (PRESIDENT)
(770) 279-7987
Entity
Organization
Contact information
Practice address
3664 CLUB DR, STE 105, LAWRENCEVILLE, GA 30044-2961
(770) 279-7987
(770) 279-8951
Mailing address
3664 CLUB DR, STE 105, LAWRENCEVILLE, GA 30044-2961
(770) 279-7987
(770) 279-8951
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012875
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
740482472C
—
GA
Enumeration date
11/20/2015
Last updated
11/20/2015
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