Organization
JACKSON DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT R JACKSON D.M.D. (MEMBER)
(801) 774-8198
Entity
Organization
Contact information
Practice address
1868 N 400 W STE 110, LAYTON, UT 84041-2191
(801) 774-8198
(801) 774-8191
Mailing address
1868 N 400 W STE 110, LAYTON, UT 84041-2191
(801) 774-8198
(801) 774-8191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6593716-9922
UT
Other
Enumeration date
05/17/2011
Last updated
05/17/2011
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