Healthcare Provider Details

I. General information

NPI: 1346382678
Provider Name (Legal Business Name): RAMANI GOWDUCHERUVU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MCCLURE BRIDGE RD BLDG G, SUITES B AND C
DULUTH GA
30096-8751
US

IV. Provider business mailing address

5198 DINANT DR
JOHNS CREEK GA
30022-6532
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-8576
  • Fax:
Mailing address:
  • Phone: 571-423-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN016148
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: