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Organization
JACKSON PERIODONTICS
Active
Organization
JACKSON PERIODONTICS
Active
Other names
Indiana Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTIN M JACKSON DDS, MSD (OWNER)
(317) 887-3180
Entity
Organization
Contact information
Practice address
45 N MADISON AVE, GREENWOOD, IN 46142-3526
(317) 887-3180
(317) 882-2718
Mailing address
45 N MADISON AVE, GREENWOOD, IN 46142-3526
(317) 887-3180
(317) 882-2718
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
12009767
IN
Other
Enumeration date
10/04/2006
Last updated
06/16/2011
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