| NPI | 1326250325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL JACKSON Owner 765-284-7242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010844A) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |