Provider Demographics
NPI:1053662643
Name:LAKKEGOWDA, SHILPA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:N
Last Name:LAKKEGOWDA
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 1:7000 PEACHTREE-DUNWOODY RD NE BLD#8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-392-0766
Mailing Address - Fax:770-392-0116
Practice Address - Street 1:7000 PEACHTREE-DUNWOODY RD NE
Practice Address - Street 2:BLDG#8
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-392-0766
Practice Address - Fax:770-392-0116
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice