Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3679 | WV |
NPI | 1063799344 |
---|---|
Provider Name | Dr. Lindsay Jackfert |
First Address | South Charleston, WV 25303-1417 |
Second Address | South Charleston, WV 25303-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2011 |
Last Update Date | 15/11/2011 |