Provider Demographics
NPI:1346491636
Name:DUVAL, ANNA N/A (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:N/A
Last Name:DUVAL
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 1:3370 SUGARLOAF PKWY STE G8
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5486
Mailing Address - Country:US
Mailing Address - Phone:615-275-6669
Mailing Address - Fax:
Practice Address - Street 1:1900 PATTERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2128
Practice Address - Country:US
Practice Address - Phone:615-320-1805
Practice Address - Fax:615-320-1548
Is Sole Proprietor?:No
Enumeration Date:2008-10-05
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001723Medicaid
TN1346491636Medicaid