Provider Demographics
NPI:1295906659
Name:FALLETTA-SWEGMAN, MARY KATHERINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:FALLETTA-SWEGMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3611 BRASELTON HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4671
Mailing Address - Country:US
Mailing Address - Phone:770-945-2733
Mailing Address - Fax:770-945-7633
Practice Address - Street 1:3611 BRASELTON HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4671
Practice Address - Country:US
Practice Address - Phone:770-945-2733
Practice Address - Fax:770-945-7633
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN010620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist