NPI | 1053667451 |
---|---|
Doing Business As | JACKSON PEDIATRIC DENTISTRY |
Entity Type | Organization |
Authorized Contact | CECILY LYNN JACKSON Registered Agent/Director 806-789-9870 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 24654) |
Enumeration Date | 2012-08-03 |
Last Update Date | 2012-08-03 |