| NPI | 1053167486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY B JACKSON Owner 210-273-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2024-04-26 |