Individual
JETORIA IRVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 ERNEST W BARRETT PKWY NW STE 200, KENNESAW, GA 30144-4513
(678) 805-8057
Mailing address
1316 HIGHWAY 314, FAYETTEVILLE, GA 30214
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015711
GA
Other
Enumeration date
07/24/2018
Last updated
09/24/2018
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