Healthcare Provider Details

I. General information

NPI: 1679317754
Provider Name (Legal Business Name): ANJANA KRISHNAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 NELSON BROGDON BLVD
BUFORD GA
30518-5412
US

IV. Provider business mailing address

4470 HASTINGS DR
CUMMING GA
30041-5869
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-2340
  • Fax:
Mailing address:
  • Phone: 678-943-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN123585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: