Individual
JAN MICHEAL SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1139 GREENE ST, AUGUSTA, GA 30901-2125
(706) 721-4288
Mailing address
1139 GREENE ST, AUGUSTA, GA 30901-2125
(706) 721-4288
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9379
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZG9379
—
SC
Enumeration date
07/19/2006
Last updated
07/08/2007
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