| Tara Blvd Family Dentistry | |
|
772 North Ave Jonesboro GA 30236-2226 | |
| (770) 892-5328 | |
| Not Available |
| Full Name | Tara Blvd Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 772 North Ave, Jonesboro, Georgia |
| Authorized Official Name and Position | Behnam Yavari (OWNER) |
| Authorized Official Contact | 7708925328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Blvd Family Dentistry 772 North Ave Jonesboro GA 30236-2226 Ph: (770) 892-5328 | Tara Blvd Family Dentistry 772 North Ave Jonesboro GA 30236-2226 Ph: (770) 892-5328 |
| NPI Number | 1306275474 |
|---|---|
| Provider Enumeration Date | 11/08/2013 |
| Last Update Date | 11/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306275474 | NPI | - | NPPES |
| 003136315A | Medicaid | GA | |
| 1235416256 | Other | GA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN014345 (Georgia) | Primary |
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