| 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 |