Provider Demographics
NPI:1396974051
Name:JUST KIDS DENTISTRY
Entity type:Organization
Organization Name:JUST KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-972-0921
Mailing Address - Street 1:1350 SCENIC HWY N
Mailing Address - Street 2:SUITE 262
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7907
Mailing Address - Country:US
Mailing Address - Phone:770-972-0921
Mailing Address - Fax:770-972-0922
Practice Address - Street 1:1350 SCENIC HWY N
Practice Address - Street 2:SUITE 262
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7907
Practice Address - Country:US
Practice Address - Phone:770-972-0921
Practice Address - Fax:770-972-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900974DMedicaid
GA188040OtherDORAL DENTAL