Provider Demographics
NPI:1639362445
Name:CHEROKEE CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:CHEROKEE CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:MAZZAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-235-2288
Mailing Address - Street 1:205 WALESKA RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2493
Mailing Address - Country:US
Mailing Address - Phone:404-479-1717
Mailing Address - Fax:404-479-1747
Practice Address - Street 1:205 WALESKA RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2493
Practice Address - Country:US
Practice Address - Phone:404-479-1717
Practice Address - Fax:404-479-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty