Provider Demographics
NPI:1356975098
Name:GWINNETT ORTHODONTICS
Entity type:Organization
Organization Name:GWINNETT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILMOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:770-921-2233
Mailing Address - Street 1:956 KILLIAN HILL RD SW STE D
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8977
Mailing Address - Country:US
Mailing Address - Phone:770-921-2233
Mailing Address - Fax:770-921-6090
Practice Address - Street 1:956 KILLIAN HILL RD SW STE D
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8977
Practice Address - Country:US
Practice Address - Phone:770-921-2233
Practice Address - Fax:770-921-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty