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General NPI Number Information
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NPI Number | 1417694217
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Entity Type | Organization
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Legal Business Name | SIMHAPURI P.C
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Dates
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Enumeration Date | 05/13/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 195 NORTH PARK TRAIL, UNIT 200A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 470-713-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 310 COALTER WAY
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City | DECATUR
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State | GA
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Zip | 30030-3321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST AND OWNER
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Name | MITHYA NEMAKAL
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Credential | DDS
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Telephone | 678-315-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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