Individual
PRASANTHI PATTABHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1165 LAWRENCEVILLE SUWANEE RD STE C, LAWRENCEVILLE, GA 30043-8741
(470) 582-9678
Mailing address
1165 LAWRENCEVILLE SUWANEE RD STE C, LAWRENCEVILLE, GA 30043-8741
(470) 582-9678
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.032725
IL
122300000X
Dentist
9696
SC
1223G0001X
General Practice Dentistry
Primary
DN122307
GA
Other
Enumeration date
07/14/2020
Last updated
06/22/2023
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