Provider Demographics
NPI:1922491356
Name:EATON, JOHN H
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:EATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 OLD SPRING HOUSE LN STE 301
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6225
Mailing Address - Country:US
Mailing Address - Phone:770-457-6558
Mailing Address - Fax:770-457-6683
Practice Address - Street 1:1776 OLD SPRING HOUSE LN STE 301
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6225
Practice Address - Country:US
Practice Address - Phone:770-457-6558
Practice Address - Fax:770-457-6683
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0097231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics