Provider Demographics
NPI:1285721118
Name:EATON, JONATHAN JAMIR (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMIR
Last Name:EATON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 NORTHLAKE PKWY
Mailing Address - Street 2:BULDING 11, SUITE 20
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4166
Mailing Address - Country:US
Mailing Address - Phone:770-934-3506
Mailing Address - Fax:
Practice Address - Street 1:2191 NORTHLAKE PKWY
Practice Address - Street 2:BULDING 11, SUITE 20
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4166
Practice Address - Country:US
Practice Address - Phone:770-934-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry