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Organization

GWINNETT PEDIATRIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ASHA YAMINI PONUGOTI D.D.S. (OWNER)
(678) 613-5095
Entity
Organization

Contact information

Practice address
2650 LAWRENCEVILLE SUWANEE RD, SUITE D, SUWANEE, GA 30024-2535
(678) 799-7675
Mailing address
2594 LOGANVILLE HWY, SUITE 106, GRAYSON, GA 30017-7848

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013843
GA

Other

Enumeration date
04/12/2013
Last updated
04/12/2013
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