Individual
JERRY JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1740 N SERVICE RD, MOORE, OK 73160-3307
(405) 794-7200
(405) 794-2266
Mailing address
555 W BENJAMIN HOLT DR, BUILDING B, STOCKTON, CA 95207-3839
(209) 476-4700
(209) 478-6890
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3903
OK
Other
Enumeration date
07/05/2006
Last updated
07/08/2007
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