Individual
DR. MUKTI GUNVANT PREMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2101 BAKER CARTER DR STE 200, LOGANVILLE, GA 30052-7466
(678) 661-5161
Mailing address
5461 OAK CHASE DR, ANTIOCH, TN 37013-4250
(615) 612-8985
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN122875
GA
Other
Enumeration date
06/14/2021
Last updated
07/26/2023
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