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General NPI Number Information
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NPI Number | 1912210246
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Entity Type | Individual
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Provider Name | VATSALA JAJOO DMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 9745 ROD RD
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City | ALPHARETTA
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State | GA
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Zip | 30022-7563
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Country | US
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Telephone | 217-220-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 OLD ALABAMA RD STE 120
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City | ROSWELL
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State | GA
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Zip | 30076-2164
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Country | US
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Telephone | 217-220-3716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028393
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122515
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License Number State | GA
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