Provider Demographics
NPI:1417193897
Name:JAIN, PARUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARUL
Middle Name:
Last Name:JAIN
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 1:1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4154
Mailing Address - Country:US
Mailing Address - Phone:404-777-7147
Mailing Address - Fax:404-777-7147
Practice Address - Street 1:1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4154
Practice Address - Country:US
Practice Address - Phone:404-777-7147
Practice Address - Fax:404-777-7147
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN614709122300000X
NY0540761223G0001X
GA0147091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist