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Individual

JANICE GIBSON JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
1600 7TH AVE S, BIRMINGHAM, AL 35233-1711
(205) 939-5174
(205) 939-9796
Mailing address
1919 7TH AVENUE SOUTH SDB BOX 58, BIRMINGHAM, AL 35294-0001
(205) 934-2340
(205) 934-7899

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3255
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009935520
AL
05
009936105
AL
05
009962890
AL
05
219143
AL
Enumeration date
11/25/2006
Last updated
10/05/2018
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