Healthcare Provider Details

I. General information

NPI: 1609942010
Provider Name (Legal Business Name): JOSEPH GRIFFIN LOOPER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 BRIARCLIFF RD NE
ATLANTA GA
30306-2142
US

IV. Provider business mailing address

1799 BRIARCLIFF RD NE
ATLANTA GA
30306-2142
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3838
  • Fax: 404-872-9491
Mailing address:
  • Phone: 404-872-3838
  • Fax: 404-872-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: