| NPI | 1962981142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JACKSON Owner 910-620-7881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 911) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |