Provider Demographics
NPI:1245613637
Name:JEN, RITZ JOY (DMD)
Entity type:Individual
Prefix:
First Name:RITZ
Middle Name:JOY
Last Name:JEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MANSELL RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1797
Mailing Address - Country:US
Mailing Address - Phone:770-642-9900
Mailing Address - Fax:
Practice Address - Street 1:800 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1797
Practice Address - Country:US
Practice Address - Phone:770-642-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist