| 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 |