Provider Demographics
NPI:1972198141
Name:YOUR JOYFUL SMILE DENTAL-MIDTOWN
Entity type:Organization
Organization Name:YOUR JOYFUL SMILE DENTAL-MIDTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:470-428-4240
Mailing Address - Street 1:275 14TH ST NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-9100
Mailing Address - Country:US
Mailing Address - Phone:470-428-4240
Mailing Address - Fax:404-289-1139
Practice Address - Street 1:275 14TH ST NW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-9100
Practice Address - Country:US
Practice Address - Phone:470-428-4240
Practice Address - Fax:404-289-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty