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Organization
ORAL HEALTHCARE PROFESSIONALS
Active
Organization
ORAL HEALTHCARE PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC G. JACKSON D.D.S. (OWNER)
(630) 963-6750
Entity
Organization
Contact information
Practice address
2033 OGDEN AVE, DOWNERS GROVE, IL 60515-2601
(630) 963-6750
(630) 963-6761
Mailing address
2033 OGDEN AVE, DOWNERS GROVE, IL 60515-2601
(630) 963-6750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026703
IL
Other
Enumeration date
09/23/2010
Last updated
09/23/2010
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