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Organization
CORE FAMILY DENTAL
Active
Organization
CORE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON DDS (OWNER)
(435) 637-2100
Entity
Organization
Contact information
Practice address
13460 N 94TH DR STE K4, PEORIA, AZ 85381-4249
(232) 231-0366
Mailing address
13460 N 94TH DR STE K4, PEORIA, AZ 85381-4249
(232) 231-0366
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/23/2020
Last updated
07/28/2020
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