Individual
DONNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
558 E MOUNT VERNON BLVD, MOUNT VERNON, MO 65712-2102
(417) 466-7184
(417) 466-4081
Mailing address
558 E MOUNT VERNON BLVD, MOUNT VERNON, MO 65712-2102
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
003465
MO
Other
Enumeration date
02/24/2012
Last updated
02/24/2012
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