Provider Demographics
NPI:1750556197
Name:JANKO, ROSENTHAL & JACKSON, DDS, PA
Entity type:Organization
Organization Name:JANKO, ROSENTHAL & JACKSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:RDA, CDA
Authorized Official - Phone:404-255-8443
Mailing Address - Street 1:755 MOUNT VERNON HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4274
Mailing Address - Country:US
Mailing Address - Phone:404-255-8443
Mailing Address - Fax:404-255-1326
Practice Address - Street 1:755 MOUNT VERNON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-255-8443
Practice Address - Fax:404-255-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0077981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty