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Organization
GOOD LIFE DENTAL
Active
Organization
GOOD LIFE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON DDS (OWNER/DENTIST)
(858) 705-5958
Entity
Organization
Contact information
Practice address
20061 E RITTENHOUSE RD, QUEEN CREEK, AZ 85142-9715
(858) 705-5958
Mailing address
250 N FAIRGROUNDS RD STE 1, PRICE, UT 84501-4201
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/03/2023
Last updated
06/09/2026
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