Provider Demographics
NPI:1912210246
Name:JAJOO, VATSALA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VATSALA
Middle Name:
Last Name:JAJOO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 OLD ALABAMA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2164
Mailing Address - Country:US
Mailing Address - Phone:217-220-3716
Mailing Address - Fax:
Practice Address - Street 1:9745 ROD RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7563
Practice Address - Country:US
Practice Address - Phone:217-220-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028393122300000X
GADN122515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN122515OtherDENTAL LICENSE