| Gwinnett Pediatric Dentistry | |
|
2650 Lawrenceville Suwanee Rd Suite D Suwanee GA 30024-2535 | |
| (678) 799-7675 | |
| Not Available |
| Full Name | Gwinnett Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2650 Lawrenceville Suwanee Rd, Suwanee, Georgia |
| Authorized Official Name and Position | Asha Yamini Ponugoti (OWNER) |
| Authorized Official Contact | 6786135095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwinnett Pediatric Dentistry 2594 Loganville Hwy Suite 106 Grayson GA 30017-7848 Ph: () - | Gwinnett Pediatric Dentistry 2650 Lawrenceville Suwanee Rd Suite D Suwanee GA 30024-2535 Ph: (678) 799-7675 |
| NPI Number | 1285077933 |
|---|---|
| Provider Enumeration Date | 04/12/2013 |
| Last Update Date | 04/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285077933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN013843 (Georgia) | Primary |
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