Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN012900 | GA |
NPI | 1033264742 |
---|---|
Provider Name | Dr. Petula Hom-Minniti |
First Address | Alpharetta, GA 30004-5728 |
Second Address | Alpharetta, GA 30004-5728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100300 | (05) | GA |
1765417 | UNITED CONCORDIA (01) | GA |
9179479 | (05) | GA |