Provider Demographics
NPI:1356444152
Name:MCCANTS, JENNIFER B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:MCCANTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MAIN ST STE B5
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1958
Mailing Address - Country:US
Mailing Address - Phone:770-663-8717
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST STE B5
Practice Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1958
Practice Address - Country:US
Practice Address - Phone:770-663-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80601223G0001X
GADN014927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice