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4046 Wetherburn Way Ste 3 Norcross GA 30092-4660 | |
| (770) 368-3297 | |
| (770) 242-3862 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4046 Wetherburn Way, Norcross, Georgia |
| Authorized Official Name and Position | Asha J Vellanki (CEO) |
| Authorized Official Contact | 7703683297 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4046 Wetherburn Way Ste 3 Norcross GA 30092-4660 Ph: (770) 368-3297 | 4046 Wetherburn Way Ste 3 Norcross GA 30092-4660 Ph: (770) 368-3297 |
| NPI Number | 1700059474 |
|---|---|
| Provider Enumeration Date | 04/02/2008 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700059474 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN012151 (Georgia) | Primary |
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