Provider Demographics
NPI:1033371091
Name:GULATI, PRIYA (DDS)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:GULATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TOWN CENTER AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 TOWN CENTER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6914
Practice Address - Country:US
Practice Address - Phone:678-448-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86321223G0001X, 1223P0221X
GADN0151221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1978Medicaid