Individual
MRS. WAUNELLE JACKSON IAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2520 WINDY HILL ROAD, SUITE 103, MARIETTA, GA 30067
(770) 953-4801
Mailing address
2520 WINDY HILL ROAD, SUITE 103, MARIETTA, GA 30067
(770) 953-4801
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10271
GA
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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