Provider Demographics
NPI:1346238706
Name:ANANTHASANE, SENGSOURIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SENGSOURIYA
Middle Name:
Last Name:ANANTHASANE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 CHARLOTTE LANE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-888-8295
Mailing Address - Fax:770-888-3437
Practice Address - Street 1:5870 CHARLOTTE LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-888-8295
Practice Address - Fax:770-888-3437
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist