MEDICARE: DR. JAYA VALLABHANENI D.D.S.

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
1	1223G0001X	General Practice Dentistry	DN 012273	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407846793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYA VALLABHANENI D.D.S.

Provider Business Mailing Address
First Line	:	625 SAINT REGIS LN
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-1653
Country	:	US
Telephone Number	:	770-993-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3273 SHALLOWFORD RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-3632
Country	:	US
Telephone Number	:	770-455-0628
Fax Number	:	770-451-7521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	03/21/2011

Similar Medicare Providers

1922139567 — AV DENTAL CARE, PC
Practice Location Address:

3273 SHALLOWFORD RD NE
ATLANTA, GA
30341-3632

Practice Phone: 770-455-0628
Practice Fax: 770-451-7521

1679782585 — J. STEPHEN BUCKLER, DMD, PC
Practice Location Address:

3632 CHAMBLEE TUCKER RD
ATLANTA, GA
30341-4418

Practice Phone: 770-491-0960
Practice Fax:

1295919322 — THANG QUOC NGUYEN DDS
Practice Location Address:

3273 SHALLOWFORD RD NE
CHAMBLEE, GA
30341-3632

Practice Phone: 770-394-6778
Practice Fax: 770-394-5060

1780530170 — DR. JEROME IRVING TOKARS JR. MD
Practice Location Address:

2919 GALAHAD DR NE
ATLANTA, GA
30345-3632

Practice Phone: 404-788-0592
Practice Fax:

1194526202 — LESLIE LIVERPOOL
Practice Location Address:

860 MARION AVE SE
ATLANTA, GA
30312-3632

Practice Phone: 404-587-6871
Practice Fax:

1821945619 — LUCAS GRANT WAKEMAN LMT
Practice Location Address:

2803 SHALLOWFORD RD NE
ATLANTA, GA
30341-5216

Practice Phone: 770-903-2603
Practice Fax:

Directions to “ DR. JAYA VALLABHANENI D.D.S.” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.