| NPI | 1952447153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN A JACKSON Dentist Owner 706-884-4254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011604) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |