MEDICARE: ASHVI MITTAL DMD

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	DN015680	GA
2	1223P0221X	Pediatric Dentistry	DN015680	GA

General Provider Information

NPI Number	:	1548754252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHVI MITTAL DMD

Provider Business Mailing Address
First Line	:	4507 QUAILWOOD DR
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3559
Country	:	US
Telephone Number	:	678-315-2844
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3022
Country	:	US
Telephone Number	:	678-696-2200
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	07/13/2023

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