Provider Demographics
NPI:1174612063
Name:PALATINI, GERALD DAVID JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:PALATINI
Suffix:JR
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 1:113 PLANTATION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2371
Mailing Address - Country:US
Mailing Address - Phone:770-748-2622
Mailing Address - Fax:770-749-1976
Practice Address - Street 1:113 PLANTATION AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2371
Practice Address - Country:US
Practice Address - Phone:770-748-2622
Practice Address - Fax:770-749-1976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0095771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice