Provider Demographics
NPI:1124676374
Name:TALEBI, SHIVA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:TALEBI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6667 VERNON WOODS DR NE, STE B30
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3213
Mailing Address - Country:US
Mailing Address - Phone:404-666-8066
Mailing Address - Fax:
Practice Address - Street 1:6667 VERNON WOODS DR NE, STE B30
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3213
Practice Address - Country:US
Practice Address - Phone:404-666-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158561223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist