| NPI | 1871652172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELBERT E JACKSON Owner 615-859-1881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN DS2474) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |