| NPI | 1386073112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE R. JACKSON Dentist/Owner 937-586-7729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30018976) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2016-08-11 |