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General NPI Number Information
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NPI Number | 1952776171
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Entity Type | Organization
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Legal Business Name | JUPITER CRUIZE, INC.
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 3521 MEMORIAL DR SUITE A
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City | DECATUR
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State | GA
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Zip | 30032-2731
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Country | US
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Telephone | 404-567-8485
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Fax | 404-941-7719
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Provider Business Mailing Address
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Address Line | 3521 MEMORIAL DR SUITE A
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City | DECATUR
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State | GA
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Zip | 30032-2731
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Country | US
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Telephone | 404-567-8485
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Fax | 404-941-7719
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. ABBAS HAIDER
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Credential | DDS
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Telephone | 404-567-8485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11863
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License Number State | GA
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