NPI | 1437270758 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL ROY JACKSON President Owner 817-293-7431 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11498) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2020-08-22 |