| NPI | 1043306467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD COREY JACKSON Managing Member 615-754-5840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8279) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |