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Individual

JACKSON VAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
20140 MCLOUGHLIN BLVD, GLADSTONE, OR 97027-2604
(971) 404-1374
Mailing address
10952 SE LENORE ST, HAPPY VALLEY, OR 97086-8789
(503) 475-9235

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12050
OR

Other

Enumeration date
07/22/2024
Last updated
11/18/2024
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