Gwinnett Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013843 Issued in GA

Legal business name

GWINNETT PEDIATRIC DENTISTRY

Practice address

2650 Lawrenceville Suwanee Rd
Suite D
Suwanee, GA 30024-2535

Phone

(678) 799-7675

NPI assigned

Apr 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Asha Yamini Ponugoti, D.D.S.NPI 1558569459

Title

Owner

Phone

(678) 613-5095

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Asha Yamini Ponugoti, DDS

  • Pediatric Dentistry
  • Grayson, GA
  • NPI 1558569459
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1285077933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2594 LOGANVILLE HWY",
            "address_2": "SUITE 106",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300177848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 LAWRENCEVILLE SUWANEE RD",
            "address_2": "SUITE D",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242535",
            "telephone_number": "678-799-7675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-12",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "PONUGOTI",
        "authorized_official_first_name": "ASHA YAMINI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-613-5095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.