Provider Demographics
NPI:1447980982
Name:BRISTOW, WILLIAM MELTON II (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MELTON
Last Name:BRISTOW
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2809
Mailing Address - Country:US
Mailing Address - Phone:803-760-0596
Mailing Address - Fax:
Practice Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 225
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5696
Practice Address - Country:US
Practice Address - Phone:770-522-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1226641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice