Provider Demographics
NPI:1578509402
Name:VELLANKI, ASHA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:J
Last Name:VELLANKI
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 1:5511 EDGERTON DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5124
Mailing Address - Country:US
Mailing Address - Phone:770-368-3297
Mailing Address - Fax:770-242-3862
Practice Address - Street 1:4046 WETHERBURN WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1892
Practice Address - Country:US
Practice Address - Phone:770-368-3297
Practice Address - Fax:770-242-3862
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0121511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice