Individual
STACY MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3400 PENROSE PL STE 107, BOULDER, CO 80301-1809
(303) 443-8250
Mailing address
291 MADDOX LANE, ERIE, CO 80516
(785) 249-2973
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2010016174
MO
1223P0221X
Pediatric Dentistry
Primary
DEN.00202791
CO
Other
Enumeration date
06/02/2010
Last updated
04/26/2023
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