Provider Demographics
NPI:1659454395
Name:J C METS INC
Entity Type:Organization
Organization Name:J C METS INC
Other - Org Name:M L KING DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORDENA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-788-9740
Mailing Address - Street 1:PO BOX 50101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302
Mailing Address - Country:US
Mailing Address - Phone:404-752-7777
Mailing Address - Fax:404-752-6877
Practice Address - Street 1:1099 M L KING JR DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:404-752-7777
Practice Address - Fax:404-752-6877
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty