Provider Demographics
NPI:1225342256
Name:NEMAKAL, MITHYA (DDS)
Entity Type:Individual
Prefix:
First Name:MITHYA
Middle Name:
Last Name:NEMAKAL
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 1:310 COALTER WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3321
Mailing Address - Country:US
Mailing Address - Phone:678-315-7977
Mailing Address - Fax:
Practice Address - Street 1:2101 BAKER CARTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7466
Practice Address - Country:US
Practice Address - Phone:678-783-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0141421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry