| NPI | 1669847521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WESLEY JACKSON Owner 412-367-2250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS026194L) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2015-12-03 |