Individual
DR. ERNEST W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 S MERAMEC AVE, CLAYTON, MO 63105-1711
(314) 615-8153
(314) 615-8303
Mailing address
3702 W TRUMAN BLVD STE 100, JEFFERSON CITY, MO 65109-4970
(573) 635-5315
(573) 635-5512
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
014969
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
406024208
—
MO
Enumeration date
10/04/2006
Last updated
07/08/2007
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