Provider Demographics
NPI:1548677222
Name:NEMATBAKHSH, SAMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:
Last Name:NEMATBAKHSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2163
Mailing Address - Country:US
Mailing Address - Phone:470-601-7888
Mailing Address - Fax:470-601-7666
Practice Address - Street 1:8080 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2163
Practice Address - Country:US
Practice Address - Phone:470-601-7888
Practice Address - Fax:470-601-7666
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice