Organization
GRAYSON PEDIATRIC DENTISTRY, P.C.
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
2594 LOGANVILLE HWY, SUITE 106, GRAYSON, GA 30017-7848
(678) 682-9819
Mailing address
12792 WATERSIDE DR, ALPHARETTA, GA 30004-7338
(678) 613-5095
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013843
GA
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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