Provider Demographics
NPI:1417694217
Name:SIMHAPURI P.C
Entity Type:Organization
Organization Name:SIMHAPURI P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-315-7977
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:
Mailing Address - Fax:
Practice Address - Street 1:195 NORTH PARK TRAIL, UNIT 200A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:470-713-7077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty