Individual
BRIAN JOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1106 ANTHONY RD, AUGUSTA, GA 30904-4423
(770) 713-2664
Mailing address
160 LULLWATER RD, ATHENS, GA 30606-4810
(770) 713-2664
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN015807
GA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/30/2017
Last updated
04/19/2022
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