Individual
KEVIN D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8101 HINSON FARM RD STE 216, ALEXANDRIA, VA 22306-3406
(703) 360-6455
Mailing address
8101 HINSON FARM RD STE 216, ALEXANDRIA, VA 22306-3406
(703) 360-6455
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401006933
VA
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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