Individual
DR. MARIO MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1013 HARP WAY, NORTH LAS VEGAS, NV 89032-7889
(702) 505-3914
Mailing address
1013 HARP WAY, NORTH LAS VEGAS, NV 89032-7889
(702) 505-3914
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4594T
NV
Other
Enumeration date
10/20/2006
Last updated
07/08/2007
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