# EARL W JACKSON DDS INC

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

## Provider details

- **NPI number:** 1669409058
- **Authorized official:** EARL WAYNE JACKSON DDS (DENTIST)
- **Authorized official phone:** (765) 674-7935

## Contact information

- **Practice address:** 3802 S ADAMS ST, MARION, IN 46953
- **Practice address phone:** (765) 674-7935
- **Practice address fax:** (765) 677-1160
- **Mailing address:** 3802 S ADAMS ST, MARION, IN 46953
- **Mailing address phone:** (765) 674-7935
- **Mailing address fax:** (765) 677-1160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5913 | IN | Yes |

## Other

- **Enumeration date:** 06/28/2006
- **Last updated:** 09/18/2007