Provider Demographics
NPI:1609029701
Name:GERALD D PALATINI, JR., DDS
Entity Type:Organization
Organization Name:GERALD D PALATINI, JR., DDS
Other - Org Name:CEDARTOWN DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-748-2622
Mailing Address - Street 1:113 PLANTATION AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2371
Mailing Address - Country:US
Mailing Address - Phone:770-748-2622
Mailing Address - Fax:770-749-1976
Practice Address - Street 1:113 PLANTATION AVE STE A
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2371
Practice Address - Country:US
Practice Address - Phone:770-748-2622
Practice Address - Fax:770-749-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty