| Grayson Pediatric Dentistry, P.c. | |
|
2594 Loganville Hwy Suite 106 Grayson GA 30017-7848 | |
| (678) 682-9819 | |
| Not Available |
| Full Name | Grayson Pediatric Dentistry, P.c. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2594 Loganville Hwy, Grayson, Georgia |
| Authorized Official Name and Position | Asha Yamini Ponugoti (OWNER) |
| Authorized Official Contact | 6786135095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grayson Pediatric Dentistry, P.c. 12792 Waterside Dr Alpharetta GA 30004-7338 Ph: (678) 613-5095 | Grayson Pediatric Dentistry, P.c. 2594 Loganville Hwy Suite 106 Grayson GA 30017-7848 Ph: (678) 682-9819 |
| NPI Number | 1598067993 |
|---|---|
| Provider Enumeration Date | 11/17/2010 |
| Last Update Date | 11/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598067993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN013843 (Georgia) | Primary |
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