Provider Demographics
NPI:1538808084
Name:DEHDASHTI, KAMYAR KAMY (DMD)
Entity type:Individual
Prefix:DR
First Name:KAMYAR
Middle Name:KAMY
Last Name:DEHDASHTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SHERIDAN DR NE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3158
Mailing Address - Country:US
Mailing Address - Phone:404-421-2830
Mailing Address - Fax:
Practice Address - Street 1:426 S ATLANTA ST STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4903
Practice Address - Country:US
Practice Address - Phone:770-248-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1226691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice