Healthcare Provider Details

I. General information

NPI: 1093766222
Provider Name (Legal Business Name): SAJITHA MENON KALATHINGAL BDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-1001
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE GC-1012
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2607
  • Fax: 706-721-6778
Mailing address:
  • Phone: 706-721-7913
  • Fax: 706-721-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDNF000328
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: