Provider Demographics
NPI:1346814092
Name:RATTLE, ALVIN JEROME JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:JEROME
Last Name:RATTLE
Suffix:JR
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 1:209 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3744
Mailing Address - Country:US
Mailing Address - Phone:225-573-4763
Mailing Address - Fax:
Practice Address - Street 1:209 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3744
Practice Address - Country:US
Practice Address - Phone:770-928-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006948-C11223G0001X
LA72121223G0001X
GADN1226561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice