# JACKSON DENTAL, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588002620
- **Authorized official:** DR. GEOFFREY A JACKSON DDS (CEO/OWNER)
- **Authorized official phone:** (352) 871-2577

## Contact information

- **Practice address:** 101 E KENNEDY BLVD, STE 300, TAMPA, FL 33602-5179
- **Practice address phone:** (352) 871-2577
- **Mailing address:** 101 E KENNEDY BLVD, STE 300, TAMPA, FL 33602-5179

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DN18870 | FL | Yes |

## Other

- **Enumeration date:** 06/11/2013
- **Last updated:** 06/11/2013