Individual
SHIPRA BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
330 PROGRESS CIR STE C, BLUE RIDGE, GA 30513-6262
(678) 365-0322
Mailing address
501 WALES DR, JOHNS CREEK, GA 30022-8404
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN123561
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2024
Last updated
08/08/2024
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