NPIMap

Organization Active NPI

Grayson Pediatric Dentistry, P.C.

  • Pediatric Dentistry
  • Grayson, GA
National Provider Identifier
1598067993
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN013843 Issued in GA
Legal business name
GRAYSON PEDIATRIC DENTISTRY, P.C.
Practice address
2594 Loganville Hwy
Suite 106
Grayson, GA 30017-7848
Phone
(678) 682-9819
NPI assigned
Nov 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN013843 GA Primary

Addresses

Primary practice location

2594 Loganville Hwy
Suite 106
Grayson, GA 30017-7848

Mailing address

12792 Waterside Dr
Alpharetta, GA 30004-7338
Phone (678) 613-5095

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289952000000",
    "number": "1598067993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12792 WATERSIDE DR",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300047338",
            "telephone_number": "678-613-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2594 LOGANVILLE HWY",
            "address_2": "SUITE 106",
            "city": "GRAYSON",
            "state": "GA",
            "postal_code": "300177848",
            "telephone_number": "678-682-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAYSON PEDIATRIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2010-11-17",
        "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": []
}

Other providers in Grayson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; 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.