Provider Demographics
NPI:1003986605
Name:KALRA, NEELU
Entity type:Individual
Prefix:DR
First Name:NEELU
Middle Name:
Last Name:KALRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 CARTERS GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2627
Mailing Address - Country:US
Mailing Address - Phone:770-232-7697
Mailing Address - Fax:
Practice Address - Street 1:3525 LAWRENCEVILLE-SUWANEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30032-3277
Practice Address - Country:US
Practice Address - Phone:678-793-9105
Practice Address - Fax:678-793-9105
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA459052833OMedicaid
GA459052833CMedicaid
GA459052833EMedicaid