Provider Demographics
NPI:1215099932
Name:VISHNU, BAWANI DAS (DMD)
Entity type:Individual
Prefix:DR
First Name:BAWANI
Middle Name:DAS
Last Name:VISHNU
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 1:4256 BILTMORE PL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9911
Mailing Address - Country:US
Mailing Address - Phone:334-430-5397
Mailing Address - Fax:
Practice Address - Street 1:4256 BILTMORE PL NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9911
Practice Address - Country:US
Practice Address - Phone:334-430-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117281223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice