Provider Demographics
NPI:1992930960
Name:MITTAL, SUNIL (DDS)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:MITTAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GARNETT ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3200
Mailing Address - Country:US
Mailing Address - Phone:678-546-1500
Mailing Address - Fax:
Practice Address - Street 1:600 GARNETT ST
Practice Address - Street 2:STE 3
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3200
Practice Address - Country:US
Practice Address - Phone:678-546-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice