| NPI | 1689993545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN E JACKSON Owner 330-533-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 19620) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 022150) |
| 122300000X Dentist (Licence: OH 14383) | |
| 122300000X Dentist (Licence: OH 30-023233) | |
| 122300000X Dentist (Licence: OH 30-016841) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-07-21 |