| NPI | 1083842660 |
|---|---|
| Former Name | JACLYN MICHELLE ACKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2012041113) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028002) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2017-03-15 |