Individual
DR. SHELLEY DANIELLE WADE BERGANSKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1380 PEACHTREE INDUSTRIAL BLVD STE 150, SUWANEE, GA 30024-3795
(770) 614-8914
(770) 614-8917
Mailing address
1380 PEACHTREE INDUSTRIAL BLVD, #150, SUWANEE, GA 30024
(770) 614-8914
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN014966
GA
390200000X
Student in an Organized Health Care Education/Training Program
DN014966
GA
Other
Enumeration date
02/21/2015
Last updated
07/21/2022
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