MEDICARE: JANICE JONES WILMOT DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	010405	GA

General Provider Information

NPI Number	:	1275582546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE JONES WILMOT DMD, MS

Provider Business Mailing Address
First Line	:	956 KILLIAN HILL RD SW
Second Line	:	SUITE D
City	:	LILBURN
State	:	GA
Zip	:	30047-3102
Country	:	US
Telephone Number	:	770-921-2233
Fax Number	:	770-921-6090

Provider Business Practice Location Address
First Line	:	956 KILLIAN HILL RD SW
Second Line	:	SUITE D
City	:	LILBURN
State	:	GA
Zip	:	30047-3102
Country	:	US
Telephone Number	:	770-921-2233
Fax Number	:	770-921-6090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	09/04/2007

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