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Individual
TERRANCE LORNE JACKSON
Active
Individual
TERRANCE LORNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.033509
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2021
Last updated
05/10/2023
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