| NPI | 1225205362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JACKSON Corporate President 573-785-6434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 14158) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |