Individual
DR. MAC ROY JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7710 W LOWER BUCKEYE RD, PHOENIX, AZ 85043-3439
(623) 387-9101
Mailing address
7646 W JULIE DR, GLENDALE, AZ 85308-5931
(541) 490-9126
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D011973
AZ
Other
Enumeration date
05/15/2023
Last updated
04/11/2024
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