| NPI | 1710552278 |
|---|---|
| Doing Business As | CHILDREN'S DENTAL SURGERY OF JACKSON |
| Entity Type | Organization |
| Authorized Contact | VAN PHI LE Credentialing Contracts Manager 267-575-2321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2022-08-24 |