| NPI | 1497086052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYANN JACKO Owner 330-658-6983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30021302) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2010-01-21 |