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General NPI Number Information
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NPI Number | 1972198141
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Entity Type | Organization
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Legal Business Name | YOUR JOYFUL SMILE DENTAL-MIDTOWN
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 275 14TH ST NW STE 100
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City | ATLANTA
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State | GA
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Zip | 30318-9100
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Country | US
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Telephone | 470-428-4240
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Fax | 404-289-1139
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Provider Business Mailing Address
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Address Line | 275 14TH ST NW STE 100
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City | ATLANTA
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State | GA
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Zip | 30318-9100
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Country | US
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Telephone | 470-428-4240
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Fax | 404-289-1139
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. TERRANCE L JETER
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Credential | DMD
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Telephone | 470-428-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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