| NPI | 1417128042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUE DEE JACKSON Gen. Dentist & Anesthesiologist/Own 800-676-2750 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MA 15374) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |