Individual
DR. JONATHAN BLAIR WALDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2419 ROSWELL RD, MARIETTA, GA 30062-4955
(770) 977-5547
(770) 509-2326
Mailing address
2419 ROSWELL RD, MARIETTA, GA 30062-4955
(770) 977-5547
(770) 509-2326
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12021
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010688324
TAX ID #
GA
Enumeration date
01/10/2007
Last updated
08/20/2024
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