| NPI | 1649638891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANIIKA R JACKSON Dentist 816-523-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008028444) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2017-02-15 |