Healthcare Provider Details

I. General information

NPI: 1750733085
Provider Name (Legal Business Name): JESSICA DIDATO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3189 MAPLE DR NE
ATLANTA GA
30305-2501
US

IV. Provider business mailing address

1350 DRESDEN DR NE UNIT 616
BROOKHAVEN GA
30319-4047
US

V. Phone/Fax

Practice location:
  • Phone: 404-383-1111
  • Fax:
Mailing address:
  • Phone: 903-413-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123674
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: