Individual
DR. JAYA VALLABHANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
3273 SHALLOWFORD RD NE, ATLANTA, GA 30341-3632
(770) 455-0628
(770) 451-7521
Mailing address
625 SAINT REGIS LN, ALPHARETTA, GA 30022-1653
(770) 993-1284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 012273
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
853472301B
—
GA
Enumeration date
10/26/2005
Last updated
03/21/2011
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