Provider Demographics
NPI:1306056601
Name:JOHN M. DORIS,D.D.S.,P.A.
Entity type:Organization
Organization Name:JOHN M. DORIS,D.D.S.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:DORIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-977-8644
Mailing Address - Street 1:1121 JOHNSON FERRY RD
Mailing Address - Street 2:320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5425
Mailing Address - Country:US
Mailing Address - Phone:770-977-8644
Mailing Address - Fax:770-971-7953
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5425
Practice Address - Country:US
Practice Address - Phone:770-977-8644
Practice Address - Fax:770-971-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0071571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty