Healthcare Provider Details

I. General information

NPI: 1275582546
Provider Name (Legal Business Name): JANICE JONES WILMOT DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 KILLIAN HILL RD SW SUITE D
LILBURN GA
30047-3102
US

IV. Provider business mailing address

956 KILLIAN HILL RD SW SUITE D
LILBURN GA
30047-3102
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-2233
  • Fax: 770-921-6090
Mailing address:
  • Phone: 770-921-2233
  • Fax: 770-921-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number010405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: