Organization
IFACE ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHOHREH GHASEMI MD (OWNER)
(954) 376-2412
Entity
Organization
Contact information
Practice address
407 BRIDLE PATH, MARIETTA, GA 30068-4911
(954) 376-2412
Mailing address
407 BRIDLE PATH, MARIETTA, GA 30068-4911
(954) 376-2412
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207Y00000X
Otolaryngology Physician
—
—
Other
Enumeration date
09/17/2024
Last updated
09/17/2024
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