Provider Demographics
NPI:1447503347
Name:IFILL, LATOYA JANAE' (DDS)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:JANAE'
Last Name:IFILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 HUDSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5020
Mailing Address - Country:US
Mailing Address - Phone:770-692-1000
Mailing Address - Fax:316-686-2744
Practice Address - Street 1:1570 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5020
Practice Address - Country:US
Practice Address - Phone:316-686-2721
Practice Address - Fax:316-686-2744
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015541223P0221X
KS61346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61346OtherDENTAL BOARD LICENSE