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NPI Code Detail

MEDICARE: GWINNETT PEDIATRIC DENTISTRY

MEDICARE: GWINNETT PEDIATRIC DENTISTRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryDN013843GA

General Provider Information

NPI Number : 1285077933
Entity Type Code : Organization
Provider Name (Legal Business Name) : GWINNETT PEDIATRIC DENTISTRY
Provider Business Mailing Address
First Line : 2594 LOGANVILLE HWY
Second Line : SUITE 106
City : GRAYSON
State : GA
Zip : 30017-7848
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2650 LAWRENCEVILLE SUWANEE RD
Second Line : SUITE D
City : SUWANEE
State : GA
Zip : 30024-2535
Country : US
Telephone Number : 678-799-7675
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. ASHA YAMINI PONUGOTI
Credential : D.D.S.
Telephone Number : 678-613-5095
Provider Enumeration Date : 04/12/2013
Last Update Date : 04/12/2013

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Directions to “GWINNETT PEDIATRIC DENTISTRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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