Provider Demographics
NPI:1942047758
Name:KARGAR, BITA
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:KARGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 OLD ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5031
Mailing Address - Country:US
Mailing Address - Phone:770-663-0333
Mailing Address - Fax:
Practice Address - Street 1:2880 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-5031
Practice Address - Country:US
Practice Address - Phone:770-663-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist