Individual
LATOYA JANAE' IFILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1570 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5020
(316) 686-2721
(316) 686-2744
Mailing address
1570 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5020
(770) 692-1000
(316) 686-2744
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN01554
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61346
DENTAL BOARD LICENSE
KS
Enumeration date
10/17/2012
Last updated
01/12/2022
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