Provider Demographics
NPI:1053013631
Name:JLM DENTAL STUDIO OF EAST POINT
Entity type:Organization
Organization Name:JLM DENTAL STUDIO OF EAST POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:770-433-1515
Mailing Address - Street 1:1784 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4148
Mailing Address - Country:US
Mailing Address - Phone:404-766-8559
Mailing Address - Fax:404-766-7742
Practice Address - Street 1:1784 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4148
Practice Address - Country:US
Practice Address - Phone:404-766-8559
Practice Address - Fax:404-766-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty