Individual
DR. DANIEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
821 W PINE ST, POPLAR BLUFF, MO 63901-4956
(573) 785-6434
(573) 785-6435
Mailing address
821 W PINE ST, POPLAR BLUFF, MO 63901-4956
(573) 785-6434
(573) 785-6435
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14158
MO
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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