| NPI | 1003909011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA C. JACKSON Owner 301-248-3810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 9883) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN4466) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |