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General NPI Number Information
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NPI Number | 1750554937
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Entity Type | Organization
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Legal Business Name | DR. ASHA J VELLANKI DDS PC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1575 LAWRENCEVILLE HWY STE G
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-4605
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Country | US
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Telephone | 678-407-9706
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Fax | 678-407-9709
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Provider Business Mailing Address
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Address Line | 1575 LAWRENCEVILLE HWY STE G
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-4605
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Country | US
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Telephone | 678-407-9706
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Fax | 678-407-9709
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Authorized Official
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Title or Position | CEO
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Name | DR. ASHA J VELLANKI
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Credential | DDS
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Telephone | 678-407-9706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN012151
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License Number State | GA
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