Organization
DANIEL JACKSON DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL JACKSON DDS (CORPORATE PRESIDENT)
(573) 785-6434
Entity
Organization
Contact information
Practice address
821 WEST PINE BLVD, POPLAR BLUFF, MO 63901-4956
(573) 785-6434
(573) 785-6435
Mailing address
821 WEST PINE BLVD, POPLAR BLUFF, MO 63901-4956
(573) 785-6434
(573) 785-6435
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14158
MO
Other
Enumeration date
05/08/2008
Last updated
05/08/2008
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