| NPI | 1295928844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN C. JACKS President 937-277-8959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 19745) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2013-06-13 |