Provider Demographics
NPI:1922256577
Name:KUMAR, PRANEETHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRANEETHA
Middle Name:
Last Name:KUMAR
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 1:619 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4284
Mailing Address - Country:US
Mailing Address - Phone:404-641-6707
Mailing Address - Fax:
Practice Address - Street 1:6370 POWERS FERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3518
Practice Address - Country:US
Practice Address - Phone:404-641-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013712122300000X
ALD0005639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist