Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN012634 | GA |
NPI | 1063550317 |
---|---|
Provider Name | Pushpa Sundareswaran |
First Address | Alpharetta, GA 30004-7330 |
Second Address | Alpharetta, GA 30022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 15/08/2014 |