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Provider Information for 1073838561

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

SUPRITI BALYAN DDS

Gender: FEMALE

Individual NPI: 1073838561

Calendar   Last Updated:  2010-03-29
  Certification Date: 

Details

Name Value
NPI 1073838561
Enumeration Date 2010-03-29
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2145 ROSWELL RD SUITE 120
MARIETTA, GA 30062-0821
United States

Phone: 770-565-1010 | Fax: 770-565-1037
View Map External Link
Primary Practice Address 2145 ROSWELL RD SUITE 120
MARIETTA, GA 30062-0821
United States

Phone: 770-565-1010 | Fax: 770-565-1037
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist GA 011733