Individual
MISS PATRICIA RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
191 HIGHWAY AND HOSPITAL ROAD, CHINLE, AZ 86503
(928) 674-7166
(928) 674-7705
Mailing address
PO DRAWER PH, CHINLE, AZ 86503
(928) 674-7166
(928) 674-7705
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.023852
OH
Other
Enumeration date
05/13/2012
Last updated
10/08/2013
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