Healthcare Provider Details

I. General information

NPI: 1033345491
Provider Name (Legal Business Name): MITCHELL JUDD SAREMBOCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOWARD ST SE UNIT 4
ATLANTA GA
30317-2339
US

IV. Provider business mailing address

201 HOWARD ST SE UNIT 4
ATLANTA GA
30317-2339
US

V. Phone/Fax

Practice location:
  • Phone: 678-464-0681
  • Fax:
Mailing address:
  • Phone: 678-464-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014159
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: