Individual
JARED WILSON BRISTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
573 CONCORD RD SE STE C, SMYRNA, GA 30082-2611
(770) 435-9046
Mailing address
573 CONCORD RD SE STE C, SMYRNA, GA 30082-2611
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN015049
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN015049
DENTAL LICENSE
GA
Enumeration date
12/05/2017
Last updated
12/05/2017
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