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General NPI Number Information
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NPI Number | 1164411674
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 435 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1219
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Country | US
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Telephone | 770-478-8700
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Fax | 770-473-8766
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Provider Business Mailing Address
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Address Line | 125 EAGLES POINTE PKWY SUITE 120
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6379
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Country | US
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Telephone | 770-473-1350
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Fax | 770-692-0098
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY LEVITT
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Credential | DDS
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Telephone | 770-478-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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