| NPI | 1215259684 |
|---|---|
| Doing Business As | EASTSIDE SMILES |
| Entity Type | Organization |
| Authorized Contact | JACKSON R BOOTH President 512-282-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23496) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |