Provider Demographics
NPI:1609959345
Name:JONESBORO DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:JONESBORO DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-477-7711
Mailing Address - Street 1:435 ARROWHEAD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1219
Mailing Address - Country:US
Mailing Address - Phone:770-477-7711
Mailing Address - Fax:770-473-8771
Practice Address - Street 1:435 ARROWHEAD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1219
Practice Address - Country:US
Practice Address - Phone:770-477-7711
Practice Address - Fax:770-473-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0102691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty