Provider Demographics
NPI:1992180111
Name:SAKTHIVADIVEL, SARANYADEVI (DMD)
Entity Type:Individual
Prefix:
First Name:SARANYADEVI
Middle Name:
Last Name:SAKTHIVADIVEL
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 1:4362 EDNA LN NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-0010
Mailing Address - Country:US
Mailing Address - Phone:267-283-8288
Mailing Address - Fax:
Practice Address - Street 1:910 WOODSTOCK RD STE 110
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8217
Practice Address - Country:US
Practice Address - Phone:770-518-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0150611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice