Individual
DR. JASON G BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3009 CHAPEL HILL RD, SUITE A, DOUGLASVILLE, GA 30135-1748
(770) 942-8288
(770) 942-9121
Mailing address
3009 CHAPEL HILL RD, SUITE A, DOUGLASVILLE, GA 30135-1748
(770) 942-8288
(770) 942-9121
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011683
GA
Other
Enumeration date
06/01/2005
Last updated
09/03/2015
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