Healthcare Provider Details

I. General information

NPI: 1174603013
Provider Name (Legal Business Name): JOHN PAUL MISTRETTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSE HILL JR DRIVE
ATLANTA GA
30303
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-1471
  • Fax: 404-730-1475
Mailing address:
  • Phone: 404-730-1471
  • Fax: 404-730-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN008955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: