Healthcare Provider Details

I. General information

NPI: 1528135613
Provider Name (Legal Business Name): JOHNATHAN S DUBIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CLAIRMONT RD. NE SUITE 195
BROOKHAVEN GA
30329-1634
US

IV. Provider business mailing address

2970 CLAIRMONT RD. NE SUITE 195
BROOKHAVEN GA
30329-1634
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-2763
  • Fax: 404-321-4745
Mailing address:
  • Phone: 404-636-2763
  • Fax: 404-321-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9803
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberGADN980
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: