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General NPI Number Information
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NPI Number | 1356975098
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Entity Type | Organization
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Legal Business Name | GWINNETT ORTHODONTICS
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 956 KILLIAN HILL RD SW STE D
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City | LILBURN
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State | GA
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Zip | 30047-8977
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Country | US
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Telephone | 770-921-2233
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Fax | 770-921-6090
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Provider Business Mailing Address
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Address Line | 956 KILLIAN HILL RD SW STE D
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City | LILBURN
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State | GA
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Zip | 30047-8977
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Country | US
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Telephone | 770-921-2233
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Fax | 770-921-6090
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | JANICE J WILMOT
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Credential | DMD, MS
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Telephone | 770-921-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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