Provider Demographics
NPI:1316009897
Name:VENKATARAMAN, VEENA BHAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:BHAT
Last Name:VENKATARAMAN
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 1:12315 CRABAPPLE ROAD
Mailing Address - Street 2:SUITE #121
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:770-569-0613
Mailing Address - Fax:770-569-0614
Practice Address - Street 1:12315 CRABAPPLE ROAD
Practice Address - Street 2:SUITE #121
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:770-569-0613
Practice Address - Fax:770-569-0614
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124081223G0001X
GA012408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582578888Medicare UPIN
GA030436166Medicare UPIN