| NPI | 1902070998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH J JACKSON President 419-738-2426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 20856) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |