Provider Demographics
NPI:1558569459
Name:PONUGOTI, ASHA YAMINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHA YAMINI
Middle Name:
Last Name:PONUGOTI
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 1:2594 LOGANVILLE HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7848
Mailing Address - Country:US
Mailing Address - Phone:678-682-9819
Mailing Address - Fax:
Practice Address - Street 1:2594 LOGANVILLE HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-7848
Practice Address - Country:US
Practice Address - Phone:678-682-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry