Individual
JOHN IACULLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2230 TOWNE LAKE PKWY, BUILDING 1100, STE 100, WOODSTOCK, GA 30189-5540
(678) 445-9191
(678) 445-9173
Mailing address
PO BOX 195, WOODSTOCK, GA 30188-0195
(678) 445-9191
(678) 445-9173
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN014111
GA
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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