Healthcare Provider Details

I. General information

NPI: 1720603616
Provider Name (Legal Business Name): ASIA LATRELLE CURRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 COMMERCE DR STE 513
DECATUR GA
30030-2618
US

IV. Provider business mailing address

1601 CHEVY CHASE RD
SAVANNAH GA
31415-7877
US

V. Phone/Fax

Practice location:
  • Phone: 404-377-7711
  • Fax:
Mailing address:
  • Phone: 706-580-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122459
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: