Individual
DAINTY J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D. O.
Contact information
Practice address
11315 PEMBROOKE SQ STE 112, WALDORF, MD 20603-4806
(301) 885-3350
(240) 222-3899
Mailing address
PO BOX 7876, UPPER MARLBORO, MD 20792-7876
(301) 254-8177
(240) 222-3899
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H0058218
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401725102
—
MD
Enumeration date
06/08/2006
Last updated
02/08/2019
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