Active NPI
Latoya Janae' Ifill, DDS
- Pediatric Dentistry
- Stockbridge, GA
National Provider Identifier
1447503347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN01554
- Practice address
- 1570 Hudson Bridge Rd
Stockbridge, GA 30281-5020 - Phone
- (316) 686-2721
- Fax
- (316) 686-2744
- NPI assigned
- Oct 17, 2012
- Last updated
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN01554 | GA | Primary |
Addresses
Primary practice location
1570 Hudson Bridge Rd
Stockbridge, GA 30281-5020
Mailing address
1570 Hudson Bridge Rd
Stockbridge, GA 30281-5020
Phone (770) 692-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61346 | Other | KS | DENTAL BOARD LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN01554 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1447503347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1570 HUDSON BRIDGE RD",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302815020",
"telephone_number": "770-692-1000",
"fax_number": "316-686-2744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 HUDSON BRIDGE RD",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302815020",
"telephone_number": "316-686-2721",
"fax_number": "316-686-2744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IFILL",
"first_name": "LATOYA",
"middle_name": "JANAE'",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-17",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN01554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BOARD LICENSE",
"identifier": "61346",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
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- Independence Optical
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.