# MAC JACKSON III DMD PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1750229423
- **Authorized official:** MR. JOHN PUGH (PRACTICE MANAGER)
- **Authorized official phone:** (360) 256-7455

## Contact information

- **Practice address:** 13115 NE 4TH ST STE 250, VANCOUVER, WA 98684-5960
- **Practice address phone:** (541) 490-9126
- **Mailing address:** 13115 NE 4TH ST STE 250, VANCOUVER, WA 98684-5960
- **Mailing address phone:** (541) 490-9126

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/24/2026
- **Last updated:** 05/08/2026