Individual
CLAYTON SCOTT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MSD
Contact information
Practice address
3934 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 897-0625
(502) 618-4514
Mailing address
4317 CHARLESTOWN RD, NEW ALBANY, IN 47150-8506
(812) 258-9626
(812) 213-4190
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10852
KY
1223P0221X
Pediatric Dentistry
12013287A
IN
Other
Enumeration date
04/24/2019
Last updated
01/17/2023
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