Provider Demographics
NPI:1649365735
Name:AUERBACH, JAY MICHAEL (D M D)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 ROSWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3317
Mailing Address - Country:US
Mailing Address - Phone:404-848-8887
Mailing Address - Fax:404-869-7755
Practice Address - Street 1:4320 ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3317
Practice Address - Country:US
Practice Address - Phone:404-848-8887
Practice Address - Fax:404-869-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics