Individual
DR. JESSE L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8650 NE SHOAL CREEK VALLEY DR, KANSAS CITY, MO 64157-8063
(816) 429-5799
Mailing address
8650 NE SHOAL CREEK VALLEY DR, KANSAS CITY, MO 64157-8063
(816) 429-5799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2010016173
MO
332BC3200X
Customized Equipment (DME)
2010016173
MO
Other
Enumeration date
05/25/2010
Last updated
11/10/2025
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