# JULIA L. JACKSON DMD LLC

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

## Provider details

- **NPI number:** 1750656203
- **Authorized official:** DR. JULIA L JACKSON DMD (CEO)
- **Authorized official phone:** (215) 906-5052

## Contact information

- **Practice address:** 900 E WADSWORTH AVE, PHILADELPHIA, PA 19150-3417
- **Practice address phone:** (215) 247-6962
- **Mailing address:** 900 E WADSWORTH AVE, PHILALDEPHIA, PA 19150
- **Mailing address phone:** (215) 247-6962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS038263 | PA | Yes |

## Other

- **Enumeration date:** 03/16/2012
- **Last updated:** 03/16/2012