# SCOTT ROBERT JACKSON DDS PC

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

## Provider details

- **NPI number:** 1932294741
- **Authorized official:** DR. SCOTT ROBERT JACKSON DDS PC (PRESIDENT)
- **Authorized official phone:** (623) 933-0550

## Contact information

- **Practice address:** 13660 N 94TH DR, SUITE A1 PLAZA DEL RIO MEDICAL CENTER, PEORIA, AZ 85381-4836
- **Practice address phone:** (623) 933-0550
- **Practice address fax:** (623) 933-2722
- **Mailing address:** 13660 N 94TH DR, SUITE \#A1, PEORIA, AZ 85381-4836
- **Mailing address phone:** (623) 933-0550
- **Mailing address fax:** (623) 933-2722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2532 | AZ | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/22/2020