Organization
A.Y. DENTAL HEALTH, INC
Active
Other names
Tara Blvd Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEHNAM YAVARI (OWNER)
(770) 892-5328
Entity
Organization
Contact information
Practice address
772 NORTH AVE, JONESBORO, GA 30236-2226
(770) 892-5328
Mailing address
772 NORTH AVE, JONESBORO, GA 30236-2226
(770) 892-5328
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN014345
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136315A
—
GA
01
—
1235416256
INDIVIDUAL NPI
GA
Enumeration date
11/08/2013
Last updated
11/08/2013
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