Provider Demographics
NPI:1912582636
Name:DAVALUR, AJAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:DAVALUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:AJAY
Other - Middle Name:
Other - Last Name:INDERJITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4561 WOODSTOCK RD STE 208-127
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4661 JEFFERSON TOWNSHIP LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1701
Practice Address - Country:US
Practice Address - Phone:678-520-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist