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Individual

DR. PETULA HOM-MINNITI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
270 SAINT CLAIRE DR, SUITE 104, ALPHARETTA, GA 30004-5728
(678) 990-8592
(678) 990-8594
Mailing address
270 SAINT CLAIRE DR, SUITE 104, ALPHARETTA, GA 30004-5728
(678) 990-8592
(678) 990-8594

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012900
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100300
GA
01
1765417
UNITED CONCORDIA
GA
05
9179479
GA
Enumeration date
01/24/2007
Last updated
09/11/2012
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