MEDICARE: JML GROUP LLC

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	122300000X	Dentist	6113	LA

General Provider Information

NPI Number	:	1851719439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JML GROUP LLC

Provider Business Mailing Address
First Line	:	3300 CANAL ST
Second Line	:	100
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6206
Country	:	US
Telephone Number	:	504-872-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 CANAL ST
Second Line	:	100
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6206
Country	:	US
Telephone Number	:	504-872-9344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRISTOL WILLIAMS
Credential	:	D.D.S.,M.D.S
Telephone Number	:	504-872-9344

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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