Healthcare Provider Details

I. General information

NPI: 1164411674
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 ARROWHEAD BLVD
JONESBORO GA
30236-1219
US

IV. Provider business mailing address

125 EAGLES POINTE PKWY SUITE 120
STOCKBRIDGE GA
30281-6379
US

V. Phone/Fax

Practice location:
  • Phone: 770-478-8700
  • Fax: 770-473-8766
Mailing address:
  • Phone: 770-473-1350
  • Fax: 770-692-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY LEVITT
Title or Position: OWNER
Credential: DDS
Phone: 770-478-8400