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Organization
ROBERT C JACKSON II D.D.S. PC
Active
Organization
ROBERT C JACKSON II D.D.S. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT CHARLES JACKSON II D.D.S (OWNER)
(315) 691-6502
Entity
Organization
Contact information
Practice address
59 NORTH MAIN STREET, EARLVILLE, NY 13332
(315) 691-6502
(315) 691-3119
Mailing address
P.O. BOX 360, 59 NORTH MAIN STREET, EARLVILLE, NY 13332
(315) 691-6502
(315) 691-3119
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
038574
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00914058
—
NY
Enumeration date
05/27/2015
Last updated
05/27/2015
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