Provider Demographics
NPI:1255400214
Name:STILES, JANET MAURITA (DDS)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MAURITA
Last Name:STILES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:JONES
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:75 PIEDMONT AVE
Mailing Address - Street 2:SUITE 1166
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2507
Mailing Address - Country:US
Mailing Address - Phone:404-688-5668
Mailing Address - Fax:404-584-2824
Practice Address - Street 1:75 PIEDMONT AVE
Practice Address - Street 2:SUITE 1166
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2507
Practice Address - Country:US
Practice Address - Phone:404-688-5668
Practice Address - Fax:404-584-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0136287B1Medicaid