Individual
DR. JONATHAN BARTOW ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
1209 JOHNS RD, AUGUSTA, GA 30904-4407
(706) 464-5758
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015635
GA
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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