Provider Demographics
NPI:1528278801
Name:DORIS, JOHN MARVIN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARVIN
Last Name:DORIS
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 1:1121 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0071571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics