Provider Demographics
NPI:1033225891
Name:ATKINSON, JOHN PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 MAIN ST
Mailing Address - Street 2:P.O. BOX 49
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1429
Mailing Address - Country:US
Mailing Address - Phone:812-649-2331
Mailing Address - Fax:812-649-2259
Practice Address - Street 1:559 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-649-2331
Practice Address - Fax:812-649-2259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist