Individual
JACOB WILEY-BLUE HOLTZCLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1725 DAWSON RD, ALBANY, GA 31707-3362
(229) 883-7891
Mailing address
315 PHILEMA RD APT 15, ALBANY, GA 31701-1245
(770) 815-0655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN016080
GA
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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