| NPI | 1588407340 |
|---|---|
| Doing Business As | DOCS DENTAL FT.JACKSON |
| Entity Type | Organization |
| Authorized Contact | AMANDA CLARK Director Of Credentialing 267-927-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-18 |